Features of primary vesicoureteric reflux detected by investigation of foetal hydronephrosis

Oliveira, Eduardo A.; Diniz, José Silvério Santos; Silva, J. M. P.; Rabelo, Eli Armando Siqueira; Pontes, Andrey Kaliff; Souza, M. F.

doi:10.1007/bf02550541

Cited by 19 publications

(9 citation statements)

References 25 publications

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“…What is less clear is whether VUR is an important factor in the development of renal dysplasia or whether it is an unrelated phenomenon occurring in a markedly malformed urinary tract. Primary VUR diagnosed after prenatal hydronephrosis is usually severe and is often associated with a congenital RD, which is primary and not the result of UTI [11][12][13]. In our group of patients with prenatal hydronephrosis (group A), we found that VUR of grades IV and V was predominant (74%) and that RD was present at diagnosis in 85% of RRU; renal hypolasia was associated with renal dysplasia in 34% of them.…”

Section: Discussionmentioning

confidence: 59%

“…It has been stated that there are different features for infants with primary VUR detected after a prenatal diagnosis of hydronephrosis. In these latter patients, primary VUR is usually severe and is often associated with congenital RD that appears to be primary and not the result of UTI [11][12][13]. It affects male more than female infants [11].…”

Section: Introductionmentioning

confidence: 99%

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Primary vesicoureteric reflux and renal damage in the first year of life

Lama¹,

Russo²,

Rosa³

et al. 2000

Pediatric Nephrology

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We retrospectively examined 93 children (47M/46F) with primary vesicoureteric reflux (VUR) followed for a mean period of 3.5 years. They were divided into two groups. Group A included 34 babies (25M/9F) with a prenatal diagnosis of pelvic dilatation. Mean age at presentation was 12 days and no urinary tract infection (UTI) occurred before our first examination. VUR was unilateral in 21 (62%) patients and bilateral in 13 (38%). It was mild (grades I-III) in 12 (25%) refluxing renal units (RRU) and severe (grades IV-V) in 35 (75%). Renal damage (RD) was present, at diagnosis, in 40 (85%) RRU. There was a greater prevalence of abnormal kidneys in male units (88%) than in female units (75%). Group B included 59 infants (22M/37F) less than 1 year old with UTI. The mean age at first examination was 7.6 months. VUR was unilateral in 32 (54%) infants and bilateral in 27 (46%), mild in 60 (70%) RRU and severe in 26 (30%). At diagnosis, 54 (63%) RRU presented RD, which was more common in females (66%) than in males (44%). Our study confirms that primary VUR associated with prenatal hydronephrosis usually affects males and is severe. VUR diagnosed after UTI, instead, is more common in females and is frequently mild. Although in the first type of reflux RD is often present at diagnosis, then probably congenital, it may always progress after UTI; hence the importance of early diagnosis and careful follow-up in each infant with primary VUR.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Primary vesicoureteric reflux and renal damage in the first year of life

Lama¹,

Russo²,

Rosa³

et al. 2000

Pediatric Nephrology

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“…In a review article, Risdon [16] called attention to pathogenic factors involved in reflux nephropathy and suggested that at least two main mechanisms operate: acquired segmental scarring due to intrarenal reflux and congenital maldevelopment (renal dysplasia). Data from series of VUR detected in investigation of fetal hydronephrosis have supported this evidence [17][18][19][20]. In the larger published series, Yeung et al [5] have shown a significantly greater prevalence of abnormal kidneys in boys (40%) than in girls (12%).…”

Section: Discussionmentioning

confidence: 72%

Gender and vesico-ureteral reflux: a multivariate analysis

et al. 2006

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The aim of this retrospective cohort study was to describe the characteristics of patients with primary vesico-ureteral reflux (VUR) with special attention to gender-specific differences. Between 1970 and 2004, 735 patients were diagnosed with VUR and were systematically followed in a single tertiary renal unit. The following variables were analyzed: race, age at diagnosis, clinical presentation, weight and height Z-score, unilateral/bilateral reflux, VUR grade, renal damage, severity of renal damage, constipation, and dysfunctional voiding. Comparison of proportion between genders was assessed by the chi-square test with Yates' correction. The logistic regression model was applied to identify independent variables associated with gender. A survival analysis was performed to evaluate VUR resolution. After adjustment, five variables remained independently associated with male gender at baseline: non-white race [Odds ratio (OR) = 1.98, 95% confidence interval (95% CI) 1.33-2.95, P=0.001], moderate/severe grade of reflux (OR=2.16, 95% CI 1.45-3.22, P<0.001), severe renal damage (OR=1.60, 95% CI 1.04-2.52, P=0.04), age at diagnosis <24 months (OR=1.79, 95% CI 1.23-2.60, P=0.002), and antenatal clinical presentation (OR=3.56, 95% CI 1.91-6.63, P<0.001). Follow-up data were available for 684 patients (93%). Median follow-up time was 69 months (range 6 months to 411 months). Girls had a greater risk of urinary tract infection (UTI) during follow-up than boys (OR=1.68, 95% CI 1.18-2.38, P=0.003). There was no difference in progression to chronic renal insufficiency (CRI) between boys (3.8%) and girls (2.4%) during this period of follow-up (OR=1.58, 95% CI 0.59-4.15, P=0.44). Gender as an isolated variable is a poor predictor of clinical outcome in an unselected series of primary reflux. Although boys had a more severe pattern at baseline, girls had a greater risk of dysfunctional voiding and recurrent UTI during follow-up.

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“…While children with Grade V VUR were excluded in the RIVUR study, this grade of VUR is seen in a small fraction of children that have VUR identified after a UTI. 35,36 More than 1 in 5 children in the RIVUR study were toilet trained, and .50% of these children exhibited BBD documented using the Farhat instrument 11 modified for US vernacular. More children in the trial will experience BBD during the 2-year observation period.…”

Section: Discussionmentioning

confidence: 99%

The RIVUR Trial: Profile and Baseline Clinical Associations of Children With Vesicoureteral Reflux

2013

PEDIATRICS

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Features of primary vesicoureteric reflux detected by investigation of foetal hydronephrosis

Cited by 19 publications

References 25 publications

Primary vesicoureteric reflux and renal damage in the first year of life

Primary vesicoureteric reflux and renal damage in the first year of life

Gender and vesico-ureteral reflux: a multivariate analysis

The RIVUR Trial: Profile and Baseline Clinical Associations of Children With Vesicoureteral Reflux

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