Ureteral Reflux in the Normal Child

Gibson, Hazel

doi:10.1016/s0022-5347(17)68882-7

Cited by 42 publications

(11 citation statements)

References 5 publications

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“…It is now well established that reflux is abnormal at any age (Gibson, 1949;Iannaccone & Pazironi, 1955;Jones & Headstream, 1958;Leadbetter, Duxbury & Dreyfuss, 1960;Lich et al, 1964). Iannaccone (1966) found transient reflux very rarely in very small normal babies, and this has also been our experience, but as a rule it should be regarded as an abnormal finding.…”

Section: Ureteric Refluxsupporting

confidence: 62%

The radiological investigation of urinary infections in children

Starer

1970

Postgraduate Medical Journal

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SummaryOne hundred children with urinary tract infections were fully investigated radiologically. More than half showed abnormalities of the urinary tract.It is concluded that full investigation of the urinary tract is justifiable at any age; it should be carried out in boys at the first infection, and in girls at the latest after the second infectioq, or if treatment did not produce the expected cure.

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Section: Ureteric Refluxsupporting

confidence: 62%

The radiological investigation of urinary infections in children

Starer

1970

Postgraduate Medical Journal

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“…In 1967 Kollermann and Ludwig published their study of VUR in children and found that the prevalence of VUR was over 60% in infants without any renal disease and that this gradually decreased to 5% in children 4 years of age [3]. Other authors have reported a lower occurrence of VUR, but the qualities of their investigations have varied a lot [13][14][15]. The prevalence of VUR is age-and gender-dependent; girls predominate when VUR is diagnosed in the evaluation of childhood UTI, and male infants have a preponderance when VUR is found in imaging for antenatal hydronephrosis or infant pyelonephritis [4].…”

Section: The Occurrence Of Vesicoureteral Refluxmentioning

confidence: 99%

Vesicoureteral reflux, a benign condition

Venhola

Uhari

2009

Pediatr Nephrol

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The combination of urinary tract infection (UTI) and vesicoureteral reflux (VUR) is commonly thought to predispose the child to pyelonephritis, renal scarring and, later in life, to hypertension or end-stage renal disease (ESRD). This paradigm has led to the active search, follow-up and treatment of VUR, and also prevention of recurrent UTI in children. The causality of VUR and ESRD is controversial, however. According to recent meta-analyses it is uncertain whether we can prevent renal scarring or ESRD by treating VUR. Studies on VUR are abundant, but the findings and conclusions are confounding. Because of the lack of evidence of the role of VUR, reasonable doubt has recently been presented on the rationale of imaging all children with UTI and treating the children with VUR. The overall importance of VUR is confounded because of the natural tendency of VUR to resolve spontaneously, its dynamic nature, and its different grades in children. The historical studies showing that VUR is much more common, even among healthy children, than usually claimed, have been forgotten. Since it seems that we are referring too many healthy children to unpleasant and possibly unnecessary imaging tests for VUR, we are uncertain when and what kind of VUR-if any-we should treat, and whether our present rationale of addressing VUR truly makes any difference to renal scarring or ESRD in children, we should critically revisit the subject of VUR.

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“…The precise incidence of VUR at birth is uncertain, because the invasive nature of cystography precludes examining normal babies, although it has been estimated at 2% [28]. However, six studies in infants (and some older children), from a time when such research was considered ethical, showed reflux in only 4 of 456 (0.9%) normal subjects, of which 3 were unilateral [29,30,31,32,33,34]. It seems reasonable to round the estimate up to 1% because the few older subjects may have had reflux and outgrown it.…”

Section: Why Maturation Cannot Occurmentioning

confidence: 99%

Do kidneys outgrow the risk of reflux nephropathy?

Coulthard

2002

Pediatr Nephrol

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Three-quarters of human kidneys have segments that will allow intrarenal reflux if the person is one of the 1% that is also born with vesicoureteric reflux (VUR). It is likely that entry of infected urine into these segments produces permanent damage within just a few days, as it does in piglets and adult pigs. This very rapid course leaves no time for delay in diagnosing and treating urine infections in infants, the group that present the greatest clinical difficulties. It is proposed that the reason why the risk of scarring starts off high and falls to virtually nil by 4 years is not due to maturation that leads to an increased resistance to scarring, but because most vulnerable subjects have already scarred their kidneys in infancy. This proposed model has important implications for clinical management. First, it suggests that current practice identifies scars in children due to urine infection, but prevents few. Second, babies known to have VUR from birth, and protected from scarring with prophylactic antibiotics, will not outgrow their scarring risk by any particular age, but will remain at risk until they outgrow their reflux. This suggests their kidneys need to be protected from scarring until then, perhaps by antibiotic prophylaxis. Third, transplant recipients of any age with refluxing ureteric anastamoses or stents will carry a risk of developing a focal scar if they acquire a urine infection, and may need protection.

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Ureteral Reflux in the Normal Child

Cited by 42 publications

References 5 publications

The radiological investigation of urinary infections in children

The radiological investigation of urinary infections in children

Vesicoureteral reflux, a benign condition

Do kidneys outgrow the risk of reflux nephropathy?

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