Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood

Lahdes-Vasama, Tuija; K, Niskanen; Rönnholm, Kai

doi:10.1093/ndt/gfl216

Cited by 55 publications

(33 citation statements)

References 20 publications

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“…The follow-up of children with renal scarring for 16-26 years after childhood pyelonephritis showed a significant reduction of individual glomerular filtration rate in the unilaterally scarred kidney [32,33]. In addition, the a Three patients with bilateral scarring in non-refluxing units long-term outcome at a mean age of 41 years (and mean follow-up of 37 years) in children with both pyelonephritis and VUR showed a lowered glomerular filtration rate (83% of patients), hypertension (50%) and proteinuria (25%) in patients with bilateral scars [20]. An increased tendency for hypertension was also found in patients with unilateral scarring [20].…”

Section: Discussionmentioning

confidence: 92%

“…Although only a few studies have analysed the long-term outcome, renal scars can result in significant sequelae [20,32,33]. The follow-up of children with renal scarring for 16-26 years after childhood pyelonephritis showed a significant reduction of individual glomerular filtration rate in the unilaterally scarred kidney [32,33].…”

Section: Discussionmentioning

confidence: 99%

“…Only these children develop post-infectious renal scarring and the incidence is 29-60% [5,15,21,24,30,35]. Long-term follow-up of children with renal scarring showed a significant reduction of renal function [20,32,33]. In contrast, children with a febrile urinary tract infection without lesion on acute-phase DMSA scintigraphy did not develop renal scarring [14,15,30].…”

Section: Introductionmentioning

confidence: 96%

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Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

et al. 2007

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The hypothesis was tested that oral antibiotic treatment in children with acute pyelonephritis and scintigraphy-documented lesions is equally as efficacious as sequential intravenous/oral therapy with respect to the incidence of renal scarring. A randomised multi-centre trial was conducted in 365 children aged 6 months to 16 years with bacterial growth in cultures from urine collected by catheter. The children were assigned to receive either oral ceftibuten (9 mg/kg once daily) for 14 days or intravenous ceftriaxone (50 mg/kg once daily) for 3 days followed by oral ceftibuten for 11 days. Only patients with lesions detected on acute-phase dimercaptosuccinic acid (DMSA) scintigraphy underwent follow-up scintigraphy. Efficacy was evaluated by the rate of renal scarring after 6 months on follow-up scintigraphy. Of 219 children with lesions on acute-phase scintigraphy, 152 completed the study; 80 (72 females, median age 2.2 years) were given ceftibuten and 72 (62 females, median age 1.6 years) were given ceftriaxone/ Eur J Pediatr (2008) ceftibuten. Patients in the intravenous/oral group had significantly higher C-reactive protein (CRP) concentrations at baseline and larger lesion(s) on acute-phase scintigraphy. Follow-up scintigraphy showed renal scarring in 21/80 children treated with ceftibuten and 33/72 with ceftriaxone/ ceftibuten (p=0.01). However, after adjustment for the confounding variables (CRP and size of acute-phase lesion), no significant difference was observed for renal scarring between the two groups (p=0.2). Renal scarring correlated with the extent of the acute-phase lesion (r=0.60, p<0.0001) and the grade of vesico-ureteric reflux (r=0.31, p=0.03), and was more frequent in refluxing renal units (p=0.04). The majority of patients, i.e. 44 in the oral group and 47 in the intravenous/oral group, were managed as out-patients. Side effects were not observed. From this study, we can conclude that once-daily oral ceftibuten for 14 days yielded comparable results to sequential ceftriaxone/ceftibuten treatment in children aged 6 months to 16 years with DMSA-documented acute pyelonephritis and it allowed out-patient management in the majority of these children.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

et al. 2007

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“…In addition, significant microalbuminuria (MA) found in our RS (þ) children supported previous reports postulating MA was an early indicator of glomerulosclerosis and hyperfiltration in RN. [26][27][28][29] On the other hand, impaired renal function with low Ccr and high Scr in our scarred patients also indicated the permanent renal damage in RN.…”

Section: Discussionmentioning

confidence: 56%

Interleukin-18, CRP and procalcitonin levels in vesicoureteral reflux and reflux nephropathy

2013

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Background: Some patients with vesicoureteral reflux (VUR) develop reflux nephropathy (RN) and a number of them progress to chronic kidney disease (CKD). However, it is unclear to predict which patient will develop RN and/or CKD. The aim of this study is to evaluate the role of Interleukin-18 (IL-18), C-reactive protein (CRP) and procalcitonin (PCT) as an indicator of RN in VUR. Methods: Ninety-three children aged 3.5-16 years with primary VUR were enrolled. Patients were divided into two groups according to the presence of renal scarring (RS). CRP, PCT, blood urea nitrogen (BUN), serum creatinine (Scr), urinary protein (Up), creatinine (Ucr) and microalbumin (Umalb), serum and urine IL-18 levels were determined during urinary tract infection (UTI) free episode. Results: BUN, Scr, Up/Ucr and Umalb/Ucr concentrations were higher whereas calculated creatinine clearance (Ccr) values were lower in RS (þ) group compared to RS (À) group. CRP, PCT, serum and urine IL-18 levels and mean urine IL-18/Cr concentrations were similar in both groups. Serum and urine IL-18 levels did not differ according to the grade of VUR. No significant correlation was found between CRP, PCT and IL-18. Conclusions: Proteinuria and microalbuminuria are valuable hallmarks of RN. CRP and PCT seem not to be reliable indicators of RN in VUR patients. Moreover, serum and urine IL-18 might not predict RN.

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“…The association between UTI and congenital abnormalities like vesicoureteral reflux (VUR) may put children at high risk of acute pyelonephritis (APN) and subsequent renal scarring (RS) [1,2]. Although the long term medical problems of VUR and infection-related renal damage are being questioned [3,4], it is believed that postpyelonephritic RS with recurrences, especially in the presence of high grade VUR, may cause future medical problems like hypertension and/or impaired kidney function [5][6][7][8]. This is the major driving force for further investigations and treatment of the first UTI.…”

Section: Introductionmentioning

confidence: 99%

The Role of Renal Ultrasound in Children With Febrile Urinary Tract Infection

Shabbeer

Nizamuddin

2018

Int J Clin Pediatr

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Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood

Cited by 55 publications

References 20 publications

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

Randomised trial of oral versus sequential intravenous/oral cephalosporins in children with pyelonephritis

Interleukin-18, CRP and procalcitonin levels in vesicoureteral reflux and reflux nephropathy

The Role of Renal Ultrasound in Children With Febrile Urinary Tract Infection

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