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Screening siblings for vesicoureteral reflux.
Jean G Hollowell1, Saul P Greenfield
1Department of Surgery (Urology), Pinnacle Health Hospitals, Camp Hill, Pennsylvania, USA.
The Journal of Urology
|October 24, 2002
Summary
Sibling screening for reflux reveals a 32% incidence of the condition. While most cases are mild, further studies are needed to determine if screening asymptomatic siblings reduces renal scarring.
Area of Science:
- Pediatric Nephrology
- Urology
- Genetics
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Familial clustering of VUR suggests a genetic component.
- Screening siblings of affected individuals is a common practice.
Purpose of the Study:
- To determine the incidence and severity of VUR and renal scarring in siblings of patients with reflux.
- To identify factors predicting a higher likelihood of VUR in siblings.
Main Methods:
- A systematic literature review of publications on sibling screening for VUR.
- MEDLINE search from 1985 to the present.
- Analysis of 11 relevant articles and 1 abstract.
Main Results:
- The mean incidence of VUR in siblings was 32%.
- Two-thirds of affected siblings had mild to moderate reflux (grades I-II).
- Sibling age inversely correlated with reflux incidence; twin relationship and absence of voiding symptoms in the index patient predicted higher reflux risk. Renal abnormality incidence was 11% in siblings with reflux. Overall incidence of reflux and renal abnormality in screened siblings was 3%.
Conclusions:
- Siblings of patients with VUR have a higher incidence of reflux than the general population.
- Current data do not confirm that screening and treating asymptomatic siblings prevents infectious renal scarring.
- Further controlled studies, considering sibling age, are necessary to establish the benefits of screening.