The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux

Goldman, Michael; Bistritzer, Tzvy; Horne, Tifha; Zoareft, Ietay; Aladjem, M

doi:10.1007/s004670050779

Cited by 68 publications

(43 citation statements)

References 20 publications

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“…Twelve studies fulfilled the criteria, seven (14 -20) presenting data for children and seven (15,18,(21)(22)(23)(24)(25) for kidneys, with two studies (15,18) giving data for both. One study (15) gave results for scans at two time points, Ͻ6 wk and at later follow-up; the earlier ones are used here.…”

Section: Overviewmentioning

confidence: 99%

Primary Vesicoureteric Reflux as a Predictor of Renal Damage in Children Hospitalized with Urinary Tract Infection

Gordon¹,

Barkovics²,

Pindoria³

et al. 2003

Journal of the American Society of Nephrology

184

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Abstract. Renal parenchymal disease after urinary tract infection (UTI) has been associated with the development of hypertension and renal functional impairment. A systematic literature review and meta-analysis was performed to determine how effectively the finding of primary vesicoureteric reflux (VUR) on micturating cystography (MCU) in children hospitalized with UTI predicted renal parenchymal disease on 99m Technetium-dimercaptosuccinic acid ( 99m Tc-DMSA) scintigraphy. Medline, Embase, and PubMed were use to find reports with original data for children hospitalized with bacteriologically-proven UTI who had undergone both MCU and 99m Tc-DMSA scintigraphy, and which also reported both positive and negative results of these tests. A meta-analysis of likelihood ratios positive and negative for MCU was then performed, including tests for heterogeneity. Twelve valid studies were found, seven with data for 537 children, with a positive 99m Tc-DMSA scan prevalence of 59% overall, and seven studies with data for 1062 kidneys, with a positive 99m Tc-DMSA scan prevalence of 36%. The likelihood ratio positive for MCU was 1.96 (95% CI, 1.51 to 2.54) for children, and 2.34 (1.53 to 3.57) for kidneys. The likelihood ratio negative was 0.71 (0.58 to 0.85) for children and 0.72 (0.61 to 0.86) for kidneys. There was evidence of heterogeneity. The meta-analysis showed that a positive MCU increases the risk of renal damage in hospitalized UTI patients by about 20%, whereas a negative MCU increases the chance of no renal involvement by just 8%. VUR is hence a weak predictor of renal damage in pediatric patients hospitalized with UTI. Physicians should be aware of the limitations of using MCU-detected primary VUR as an effective screening test for renal damage in this population. Furthermore, the pathogenesis of renal damage in such patients is probably complex because it is often detected without demonstrable VUR.

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Section: Overviewmentioning

confidence: 99%

Primary Vesicoureteric Reflux as a Predictor of Renal Damage in Children Hospitalized with Urinary Tract Infection

Gordon¹,

Barkovics²,

Pindoria³

et al. 2003

Journal of the American Society of Nephrology

184

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“…No presente estudo, a porcentagem de pacientes com cicatriz renal foi semelhante à descrita na literatura, cuja incidência varia entre 30% a 70% [15][16][17][18][19] . A variação desta incidência em parte é influenciada pelo método de diagnós-tico da cicatriz renal.…”

Section: Discussionunclassified

Renal scars in children with primary vesicoureteral reflux

Macedo¹,

Bastos²,

Riyuzo³

2003

J Pediatr (Rio J)

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ResumoObjetivo: verificar a incidência de cicatrizes renais em crianças com refluxo vesicoureteral primário, comparando com sexo, idade no diagnóstico, infecção febril, grau do refluxo e tipo de bactéria.Métodos: estudo retrospectivo de 58 crianças, com idade entre dois meses a 11 anos, apresentando refluxo vesicoureteral primário, detectado pela uretrocistografia miccional, após episódio documentado de infecção urinária. Diagnóstico de cicatriz renal foi obtido pela cintilografia com DMSA cinco meses, no mínimo, após o tratamento da infecção urinária; em 40 crianças, o exame foi repetido após período de seis meses a seis anos.Resultados: 45 crianças (77,6%) eram meninas e 13 (22,4%) eram meninos, 51,7% com idade menor ou igual a 2 anos. A incidência de cicatriz renal foi de 55,2%. Houve maior proporção significativa de cicatrizes renais no sexo feminino, na presença do sintoma febre e no refluxo dilatado (III, IV e V). Presença de febre e sexo feminino foram fatores de risco significativos na ocorrência de cicatriz renal (febre -OR= 6,19, e sexo feminino -OR= 4,12). Houve tendência da presença de cicatriz renal em maiores de 2 anos. O intervalo entre início dos sintomas e a primeira consulta foi maior nas crianças com cicatrizes renais. Novas cicatrizes renais foram observadas em 12,5%.Conclusão: a presença de febre e sexo feminino foram fatores de risco para presença de cicatrizes renais, principalmente no refluxo vesicoureteral dilatado. A alta incidência de cicatrizes renais neste estudo pode estar relacionada ao retardo do diagnóstico do refluxo vesicoureteral.J Pediatr (Rio J) 2003;79(4):355-62: refluxo vesicoureteral primário, cicatriz renal. AbstractObjective: to determine the incidence of renal scars in children with primary vesicoureteral reflux taking into consideration the following variables: sex, age at diagnosis, febrile urinary infection, degree of reflux and bacteria specimen.Method: retrospective study of 58 children with age ranging from 2 months to 11 years, presenting primary vesicoureteral reflux detected by voiding cystourethrogram after documented episode of urinary tract infection. The diagnosis of renal scarring was obtained by dimercaptosuccinic acid scan 5 months after the treatment of the urinary infection; in 40 children the dimercaptosuccinic acid scan was performed again from 6 months up to 6 years after the treatment.Results: 45 children (77.6%) were girls and 13 (22.4%) were boys, 51.7% were 2 years old or younger. The incidence of renal scarring was 55.2%. There was significant higher proportion of renal scars in girls, when the patients presented fever and dilated vesicoureteral reflux (III, IV, V). Fever and female sex were risk factors for the development of renal scars (fever -ODDS ratio = 6.19 and female sex -ODDS ratio = 4.12). There was a prevalence of renal scars in children over 2 years old. The interval between the beginning of the symptoms and the first medical visit was longer in the children with renal scars. New renal scars were observed in 12.5%.Conclusions: feve...

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“…Several conditions can lead to the development of renal scarring, whether congenital or acquired (3). Nevertheless, it is widely known that the vesicoureteral reflux, especially from grade III on, would be an alteration more commonly associated to pyelonephritis in children (5,6), and this, in turn, would result in the appearance of renal scars in the majority of patients (3).…”

Section: Discussionmentioning

confidence: 99%

“…It is well established that the risk of developing a renal scar increases accordingly to the degree of reflux (5,6). Theses data warrant the need of diagnosing the renal scar, what is currently performed by scintigraphy with dimercaptosuccinic acid (DMSA), regarded as the best current method for detecting such condition (3,(7)(8)(9).…”

Section: Introductionmentioning

confidence: 99%

Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux

Araújo¹,

Barroso²,

Barroso³

et al. 2003

Int. braz j urol.

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Purpose: To assess the value of intravenous urography (IVU) in detecting and grading the renal scar, comparing its results with those of scintigraphy with dimercaptosuccinic acid (DMSA).Materials and Methods: The study included 43 children investigated by DMSA and IVU, who had vesicoureteral reflux diagnosed and classified through voiding cystourethrography.Results: Among the kidneys with reflux, there was agreement between the results of DMSA and IVU concerning the presence and the absence of scars in 82.4% of the cases. Based on the results obtained, IVU would have a sensitivity of 66.6%, specificity of 94.4%; accuracy of 82.5%; positive predictive value (PPV) of 90% and negative predictive value (NPV) of 79%, when compared with DMSA results. Our data also confirm the close relation between the reflux grade and the presence of renal scar, since 75% of the kidneys with grade IV and V reflux presented scars. In relation to the grading of nephropathy, in 78% of patients the classification of the scar by both methods was identical. The highest disagreement was verified in the group with segmental scar on DMSA, where 41.6% of the kidneys were classified as normal on IVU.Conclusion: The data obtained confirm that the scintigraphy with DMSA is essential in the investigation of patients with renal scar, and cannot be replaced by IVU, due to its low sensitivity and lower ability of satisfactory grading.

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The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux

Cited by 68 publications

References 20 publications

Primary Vesicoureteric Reflux as a Predictor of Renal Damage in Children Hospitalized with Urinary Tract Infection

Primary Vesicoureteric Reflux as a Predictor of Renal Damage in Children Hospitalized with Urinary Tract Infection

Renal scars in children with primary vesicoureteral reflux

Comparative study between intravenous urography and renal scintigraphy with DMSA for the diagnosis of renal scars in children with vesicoureteral reflux

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