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Reflux nephropathy in infancy: a comparison of infants presenting with and without urinary tract infection
B Sweeney1, S Cascio, M Velayudham
1Children's Research Centre, Our Lady's Hospital for Sick Children, Dublin, Ireland.
Insights
Early detection of high-grade vesicoureteral reflux (VUR) through screening, before urinary tract infection (UTI) occurs, leads to a lower incidence of renal scarring. Prompt treatment of VUR in infants can prevent kidney damage.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys.
- High-grade VUR (grades IV and V) in infants increases the risk of renal scarring and potential kidney damage.
- Urinary tract infections (UTIs) are often associated with VUR and can exacerbate renal scarring.
Purpose of the Study:
- To compare the incidence of renal scarring in infants with high-grade VUR.
- To differentiate between infants presenting with and without a urinary tract infection at diagnosis.
Main Methods:
- Retrospective review of 127 infants (81 male, 46 female) with grade IV or V primary VUR.
- Analysis of dimercapto-succinic acid (DMSA) scans and voiding cystourethrography (VCUG) at diagnosis and follow-up.
- Patients underwent anti-reflux procedures and were followed for 2 to 16 years.
Main Results:
- 76% of patients (97/127) presented with a UTI.
- Initial DMSA scans showed scarring in 38% of grade IV and 67% of grade V refluxing units.
- In patients diagnosed before UTI (24%), scarring was observed in 29% of grade IV and 36% of grade V units, significantly lower than UTI-presenting groups.
Conclusions:
- The incidence of reflux nephropathy is lower in grade V VUR cases detected by screening before UTI.
- Early detection and treatment of grade V VUR, facilitated by screening, can reduce renal damage.
- Screening protocols may help prevent long-term kidney complications in infants with high-grade VUR.
Purpose:
We compared the incidence of renal scarring in infants with high grade vesicoureteral reflux in those presenting with and without urinary tract infection.
Methods And Methods:
We reviewed the medical records of 81 male and 46 female infants (194 renal refluxing units) with a mean age of 4 months who had grade IV or V primary vesicoureteral reflux and underwent an anti-reflux procedure between 1984 and 1997. Dimercapto-succinic acid (DMSA) scans and voiding cystourethrography were performed in all cases. Patients were followed for 2 to 16 years, including 90% for greater than 3 years. Renal ultrasound and DMSA scan were done at followup.
Results:
A total of 97 patients (76%) (148 refluxing renal units) presented clinically with urinary tract infection. The initial DMSA scan demonstrated renal scarring in 40 of the 106 grade IV (38%) and 28 of the 42 grade V (67%) refluxing renal units. There was no scarring on followup in previously normal refluxing renal units. Of the patients 30 (24%) (46 refluxing renal units) were diagnosed before a urinary tract infection developed, 16 underwent screening due to vesicoureteral reflux in a sibling and in 10 reflux was initially suspected due to hydronephrosis on prenatal ultrasound. In the remaining 4 patients vesicoureteral reflux was suspected during abdominal ultrasound to investigate abdominal pain, jaundice, associated hypospadias and fetal alcohol syndrome, respectively. DMSA scan showed evidence of scarring in 6 of 21 grade IV (29%) and 9 of 25 grade V (36%) refluxing renal units in this group. Followup revealed scarring in only 1 previously normal refluxing renal unit.
Conclusions:
The incidence of reflux nephropathy in primary grade V vesicoureteral reflux is lower in cases detected by screening and with treatment it remained lower than in cases of urinary tract infection that presented clinically. Early treatment of grade V vesicoureteral reflux made possible by screening may prevent renal damage.