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Unilateral vesicoureteric reflux: Low prevalence of contralateral renal damage
C Polito1, P F Rambaldi, L Mansi
1Department of Pediatrics, Nuclear Medicine, Second University of Naples, Via S. Andrea celle Dame, 4, I-80138 Naples, Italy.
Insights
Children with urinary tract infections and vesicoureteric reflux (VUR) face a high risk of kidney damage. This risk, encompassing both congenital and acquired damage, escalates with the severity of VUR.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Vesicoureteric reflux (VUR) is a condition where urine flows backward from the bladder to the ureters or kidneys.
- Urinary tract infections (UTIs) are common in children and can be associated with VUR.
- Renal damage in children with VUR is a significant concern, potentially leading to long-term complications.
Purpose of the Study:
- To evaluate the risk of renal damage in pediatric patients diagnosed with VUR.
- To differentiate between congenital and acquired renal damage patterns in children with VUR.
Main Methods:
- Retrospective review of 187 children with unilateral primary VUR following UTI.
- Dimercaptosuccinic acid (DMSA) renal scintigraphy to assess renal uptake patterns.
- Classification of renal damage into global reduction (GR), focal defects (FD), and shrunken kidney (SK).
Main Results:
- Renal damage was significantly more prevalent in refluxing kidneys (36.9%) compared to non-refluxing kidneys (3.2%).
- Global reduction (GR) indicating congenital damage was observed in 19% of refluxing kidneys.
- Focal defects (FD) suggesting acquired damage were present in 15.5% of refluxing kidneys.
- Higher VUR severity correlated with an increased probability of renal damage.
Conclusions:
- The refluxing kidney in children with UTI and VUR is highly susceptible to both congenital and acquired renal damage.
- The severity of VUR directly influences the risk of developing renal damage.
- Early identification and management of VUR are crucial to mitigate renal damage in children.
Objective:
We assessed the risk for the occurrence of renal damage in children with vesicoureteric reflux (VUR).
Study Design:
We reviewed the records of 187 consecutive children, aged 3.8 +/- (SD) 2.8 years, with unilateral primary VUR diagnosed after urinary tract infection (UTI). Dimercaptosuccinic acid renal scintigraphy was performed 4 to 6 months after the last UTI. Three patterns of renal damage were identified: global reduction (GR) of renal radionuclide uptake (20% to 40% of relative uptake), focal defects (FD) in uptake, and shrunken (relative uptake <20%) kidney (SK). We assumed that in these subjects FD indicated postpyelonephritic damage and that GR indicated congenital renal damage.
Results:
Scintigraphic renal damage of any type was present in 36.9% of the refluxing and in 3.2% of the nonrefluxing kidneys (odds ratio [OR], 17.6; 95% CI, 7.4 to 41.9). FD were present in 15.5% and 2.7% (OR, 6.7; CI, 2.5-17.6), GR in 19% and 0.5% (OR, 44.3; CI, 6.1 to 327.2), and SK in 6.9% and 0%, respectively. Patients with severe VUR showed a higher probability of renal damage than those with nonsevere VUR.
Conclusions:
In children with UTI and VUR, the refluxing kidney is most at risk of both congenital and acquired renal damage, and this risk increases with severity of reflux.