Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

Abstract

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:

Is there any relation between connective tissue growth factor and scar tissue in vesicoureteral reflux?

“…In accordance with the literature, this has confirmed the hypothesis that as VUR stage increases, the risk for renal scarring also increases. 23 In our study, age at diagnosis was found to be significantly higher in the VUR with scar group than in the VUR without scar group. Increasing age at the diagnosis of VUR correlates with increasing incidence of renal scarring such that it is observed in 10% of preterm infants, 26% in children under 8 years, 47% in children older than 8 years and 94% in adults.…”

“…Therefore, lending evidence to the fact that early diagnosis of VUR is important for the development of RPS. 23 In experimental diabetic nephropathy, overexpression of CTGF in glomeruli and tubulointerstitium increased glomerulosclerosis, tubulointerstitial fibrosis, and proteinuria. [25][26][27] The urinary CTGF levels were normalized in these patients, in consistence with the improvement of tubular dysfunction with antiproteinuric measures.…”

Guidelines for the medical management of pediatric vesicoureteral reflux

“…VUR is often diagnosed in patients with fUTI, and because of VUR diagnosed at screening in infants with fetal hydronephrosis detected by ultrasound, infant health checks using ultrasound and thorough examination for familial VUR are also on the rise . In patients with BBD, VUR is detected during examination for voiding and/or storage symptoms.…”

“…VUR occurs in 36–56% of children with UTI, and the detection rate increases with earlier age of onset of UTI; VUR was detected in 70%, 25%, 15% and 5.2% of UTI patients if onset was in infancy, at age 4 years, at age 12 years and in adulthood, respectively . Also, the frequency of renal damage increased with increased frequency of UTI, and renal scarring was found in 26%, 38% and 80% of patients who had no recurrence of UTI, had one recurrence and had two or more recurrences, respectively …”

Incidence of Urinary Tract Infection Among Siblings of Children With Vesicoureteral Reflux

“…Most studies have reported renal cortical anomalies on ultrasound or DMSA scan in less than 3% of VUR-positive siblings 2,5,13,21,23 . Recent data from one cohort conflicts with these general findings; Hunziker et al found that 46% of screened siblings had Grade IV-V VUR, and 15% had defects seen on renal scintigraphy 30 . However, this series was limited to siblings of index patients with dilating VUR (Grade III-V), and 37% of index patients had renal scarring; this sample may reflect a more severe end of the VUR spectrum than most sibling series.…”