Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial

Smellie, J. M.; Barratt, T. M.; Chantler, C; Gordon, Isky; Prescod, Nina; Ransley, Philip G.; Woolf, Adrian S.

doi:10.1016/s0140-6736(00)04520-7

Cited by 234 publications

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“…Pediatrics 2014;133:e933-e937 Accepted for publication Jan 3, 2014 Vesicoureteral reflux (VUR) is the most common disease of the urinary tract in children, 1 occurring in 1% to 2% of the pediatric population and in 30% to 40% of children presenting with a urinary tract infection (UTI). 2,3 The familial nature of VUR is well recognized. Several studies have shown that siblings of children with VUR are at much higher risk for reflux than the general pediatric population with a reported prevalence between 26% and 50%.…”

Section: Discussionmentioning

confidence: 99%

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

2014

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WHAT'S KNOWN ON THIS SUBJECT:The familial nature of vesicoureteral reflux (VUR) is well recognized. Several studies have shown that siblings of children with VUR are at much higher risk for reflux than the general pediatric population with a reported prevalence between 26% and 50%. WHAT THIS STUDY ADDS:There is increased risk of renal cortical abnormalities in siblings with a previous urinary tract infection, siblings with high-grade VUR, and siblings .1 year of age. This information may be useful when counseling parents about the risk of familial VUR. abstract OBJECTIVE: Screening siblings of index patients with vesicoureteral reflux (VUR) has been proposed to identify children who are at risk for renal damage. However, screening siblings for VUR remains controversial. We investigated the prevalence of VUR and renal cortical abnormalities in the sibling population in a large cohort of families with VUR.METHODS: Between 1998 and 2012, parents of index patients with grade III to V VUR were asked permission to screen siblings ,6 years of age for VUR. Siblings were divided into 2 groups: siblings with a documented history of a previous urinary tract infection (UTI) and siblings who were screened for VUR and never had a UTI. A logistic regression model was used to determine independent risk factors associated with renal cortical abnormalities such as history of presentation, age, gender, and grade of VUR.RESULTS: There were 318 siblings in 275 families in the study. VUR was found after screening in 190 (60%) siblings and after a UTI in 128 (40%). Multivariate analysis revealed that siblings who had a previous UTI (odds ratio: 3.38), siblings with high grade reflux (odds ratio: 3.62), and siblings over 1 year of age (odds ratio: 2.84) were the most significant independent risk factors associated with renal cortical abnormalities. CONCLUSIONS:There is increased risk of renal cortical abnormalities in siblings with a previous UTI, siblings with high-grade VUR, and siblings over age 1 year. This information may help to counsel parents about the risk of VUR and reflux nephropathy in familial VUR. Pediatrics 2014;133:e933-e937 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

2014

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“…21 VUR then was classified as no VUR (grade 0), low-grade VUR (grades 1 and 2), and high-grade VUR (grade Ն3). 12,13,20,22 PCT At admission, the patient's serum PCT was measured prospectively using the LUMItest PCT immunoluminometric assay (BRAHMS, Hennigsdorf, Germany).…”

Section: Outcome Definitionmentioning

confidence: 99%

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Leroy¹

2005

Pediatrics

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ABSTRACT. Objective. A first febrile urinary tract infection leads to the diagnosis of vesicoureteral reflux in 20% to 40% of children. Systematic voiding cystourethrography then is recommended. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, it is irradiating, painful, and expensive. Thus, selective approaches are needed. Because procalcitonin has been shown to be associated with severe pyelonephritis and renal scars, which are correlated to vesicoureteral reflux, we analyzed its relationship with vesicoureteral reflux.Methods. A retrospective hospital-based cohort study included all children who were 1 month to 4 years of age and had a first febrile urinary tract infection. Univariate and multivariate analyses were performed.Results. Among 136 patients included, 25% had vesicoureteral reflux. The median procalcitonin concentration was significantly higher in children with reflux than in those without (1.2 vs 0.6 ng/mL). High procalcitonin (>0.5 ng/mL) was associated with reflux (odds ratio [OR]: 4.6; 95% confidence interval [CI]: 1.6 -16.2). After logisticregression adjustment for all potential confounders, the association remained significant (OR: 4.9; 95% CI: 1.7-14.0). The relationship was stronger for high-grade (>3) reflux (OR: 8.7; 95% CI: 1.2-382) than low-grade reflux (OR: 3.6; 95% CI: 1.1-15.3). High procalcitonin sensitivities were 85% (95% CI: 70 -94) and 92% (95% CI: 65-99) for all-grade and high-grade reflux, respectively, with 44% specificity (95% CI: 35-54).Conclusion. High procalcitonin is a strong and independent predictor of vesicoureteral reflux and could be used to identify low-risk patients to avoid unnecessary voiding cystourethrography. U rinary tract infection (UTI) is one of the most frequent bacterial infections in children. 1 It has been estimated that 7% of girls and 2% of boys will have a UTI before 6 years of age. 2 Vesicoureteral reflux (VUR) is diagnosed at the time of the first febrile UTI in 20% to 40% of children. 3 VUR is a risk factor for relapsing UTI, renal scarring, hypertension, and renal failure. 3 Thus, pediatric societies 4-6 have recommended systematic voiding cystourethrography after the first febrile UTI in children. However, for 60% to 80% of the children, voiding cystourethrography is a posteriori normal. Moreover, this procedure has been associated with a risk for iatrogenic UTI 7 and is irradiating, particularly for gonads, 8 painful, 9 and expensive. 10 Therefore, it would be useful to be able to predict the absence of VUR so as to avoid unnecessary voiding cystourethrography. 8 Two predictive tools have been proposed to define selective approaches for voiding cystourethrography. Renal ultrasonography alone, regardless of the criteria chosen, was shown to be poorly sensitive for VUR prediction. 11-14 A highly sensitive VUR risk score, combining clinical, biological, and radiologic variables, was also proposed, 15 but we have shown that this score was poorly reproducible. 16 Thus, new predictors of VUR afte...

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“…1,2 The association of VUR, febrile UTI, and renal parenchymal damage is well recognized. Reflux nephropathy is a cause of childhood hypertension and chronic renal failure.…”

Section: Vur (J Pediatr 2012;-:---)mentioning

confidence: 99%

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Hunziker

Mohanan

D’Asta

et al. 2012

The Journal of Pediatrics

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Objective To evaluate the incidence of febrile urinary tract infection (UTI) after successful endoscopic correction of intermediate and high-grade vesicoureteral reflux (VUR).Study design Medical records of 1271 consecutive children (male, 411; female, 903) who underwent successful endoscopic correction of VUR were reviewed. Factors potentially influencing postoperative UTIs, such as history of presentation, age, sex, grade of VUR, renal scarring, and agent used for the endoscopic injection, were analyzed.Results Febrile UTI developed in 73 children (5.7%) after successful endoscopic correction of VUR. Thirty-nine children had a single episode of UTI, and 34 children had two or more episodes at 1 month to 5.9 years (median, 1 year) after correction of VUR. With multivariate analysis, female sex (P < .001), history of preoperative bladder/ bowel dysfunction (BBD; P = .005), and BBD after endoscopic correction (P = .001) were revealed to be the most important independent risk factors for a febrile UTI after successful correction of VUR. ConclusionsThe incidence of febrile UTIs after successful correction of intermediate and high grade VUR is low.Female sex and BBD were the most important risk factors in the development of febrile UTI. Our data supports the importance of assessing bladder and bowel habits in older children with febrile UTIs after endoscopic correction of VUR. (J Pediatr 2012;-:---).V esicoureteral reflux (VUR) is the most common urinary tract abnormality in pediatrics, occurring in 1% to 2% of children, including 30% to 40% of children with urinary tract infection (UTI). 1,2 The association of VUR, febrile UTI, and renal parenchymal damage is well recognized. Reflux nephropathy is a cause of childhood hypertension and chronic renal failure. 3 Marra et al reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure, and found that those with VUR accounted for 26% of all children with chronic renal failure. The various treatment options currently available for VUR are: (1) long term antibiotic prophylaxis; (2) open surgical treatment; (3) minimally invasive endoscopic treatment; and (4) observation or intermittent therapy with management of bladder/bowel dysfunction (BBD) and treatment of UTI as they occur.Since United States Food and Drug administration approval in 2001 of dextranomer hyaluronic acid (Dx/HA) as a tissue augmenting substance for subureteral injection, endoscopic treatment has become a widely accepted minimally invasive alternative in the management of VUR.The main goals of treatment of children with VUR are to prevent renal parenchymal damage and morbidity associated with recurrent febrile UTIs. Relatively few studies have examined the incidence of febrile UTIs after successful resolution of VUR with endoscopic injection. The duration of follow-up in most series has been short, with conflicting rates of incidence of UTI. Febrile UTIs after successful resolution of VUR have been reported a...

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Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial

Cited by 234 publications

References 20 publications

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

Procalcitonin as a Predictor of Vesicoureteral Reflux in Children With a First Febrile Urinary Tract Infection

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

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