Renal damage in vesico‐ureteric reflux

Abstract

Student's t -test and the chi-square test were used for the statistical analysis. RESULTSIn all, 282 refluxing and 112 nonrefluxing units were assessed. Renal damage was detected in 188 of 282 units with VUR (67%) and in 18 of 112 (16%) contralateral nonrefluxing kidneys. The mean AU was 18.7% in kidneys with VUR and 29% in nonrefluxing units ( P < 0.001). The mean ( SD ) AU decreased from lower to higher grades of VUR, i.e. grade 0 VUR (group A), 28.97 (9.71); grade 1-3 (group B), 21.28 (8.33); grade 4-5 (group C), 14.78 (8.02). The differences were statistically significant (A vs B, B vs C, both P < 0.001). Renal damage was differently distributed in the three groups: 69 of 109 kidneys (63%) in group C (MS prevalent), 39 of 173 (22.5%) in group B (SS prevalent) and 17 of 112 (15.2%) in group A. There was no significant difference in the distribution of renal damage subtypes in patients aged <or >2 years (SS 19.6% vs 17.9%, MS 29.6% vs 30.1%, small size 48.2% vs 46.3%). The VUR was severe (group C) in 65% of patients aged <2 years and in 46% aged >2 years (chi-square, P = 0.016). CONCLUSIONSVUR is commonly associated with renal damage. Age (< or >2 years) did not significantly influence the kidney lesion subtype. Reduced parenchymal function (AU) progressively decreased with the severity of VUR. Focal MS, reduced size and relative uptake were significantly more common in severe VUR, leading to multifocal lesions and hypo-dysplasia. Renal scarring was present in up to 15% of contralateral nonrefluxing kidneys. Severe VUR behaved differently from lesser VUR in the renal scan parenchymal uptake.

Predictors of renal scar in children with urinary infection and vesicoureteral reflux

“…Further DMSA scans were obtained 4-6 months after a breakthrough febrile UTI recurrence to determine progressive or new scarring as new hypoactive foci or decrease in DMSA uptake. An abnormal DMSA scan was classified as cortical defects with ≥1 scarred areas or diffuse reduced uptake (<45%) with small renal size [20]. All children with reflux grade >I and/or hypoactive areas on the DMSA scan were prescribed antibacterial prophylaxis with amoxicillin (10 mg/kg per day), cotrimoxazole (1-2 mg/kg per day) or nitrofurantoin (1-2 mg/kg per day) in accordance with their ages [1].…”

Predictive value of clinical and laboratory variables for vesicoureteral reflux in children

“…UTI was investigated in the pediatric age group when one or more of the following were present: (1) neonatal period-toxic appearance, irritability, unstable body temperature, jaundice, vomiting, or feeding problems, (2) infancy and toddler period-fever, vomiting, diarrhea, poor growth, abdominal pain, or dysuria, and (3) school-child and adolescence period-fever, dysuria, or loin pain [18]. UTI was diagnosed when one or more of the abovementioned symptoms were associated with a monoculture with =10 5 organism/ml in urine collected by catheter and midstream clean-void samples from infants and older toilet-trained children, respectively.…”

“…The most concerning issue in an infant or child with UTI is the probability of underlying genitourinary anomalies and vesicoureteral reflux (VUR), which is frequently associated with renal scarring and eventually end-stage renal disease [1][2][3][4]. Therefore, the American Academy of Pediatrics recommends a voiding cystourethrography (VCUG) or radionuclide cystography at the earliest convenient time for children presenting with UTI [5].…”

Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias

“…16 Lee y col. informaron que el reflujo en los niños aumentó el riesgo de nefroesclerosis; sin embargo, no establecieron una correlación entre el grado de RVU y la esclerosis. 17 Peru y col. describieron una tasa elevada de nefroesclerosis (37,1%) en los pacientes con RVU de grado 1 y una tasa aún mayor (61,5%) en los pacientes con RVU de grado 4-5.…”