Renal parenchymal damage in sibling vesicoureteric reflux

Area of Science:

• Pediatric Nephrology
• Urology
• Genetics

Background:

• Vesicoureteric reflux (VUR) is a condition where urine flows backward from the bladder to the ureters.
• Renal damage can occur in children with VUR, particularly after urinary tract infections (UTIs).
• Screening for hereditary VUR in siblings of affected patients is crucial for early detection and management.

Purpose of the Study:

• To compare the incidence and severity of renal damage in siblings with a history of UTI versus asymptomatic siblings diagnosed with VUR through screening.
• To evaluate the long-term implications of VUR presentation on renal health in pediatric patients.

Main Methods:

• Retrospective review of medical and radiological records of VUR patients and their siblings diagnosed between 1990 and 2000.
• Analysis of presentation mode (UTI vs. screening), VUR grade, and presence of renal damage using dimercaptosuccinic acid (DMSA) scans.
• Comparison of reflux nephropathy rates between symptomatic and asymptomatic siblings.

Main Results:

• Vesicoureteric reflux (VUR) was identified in 226 siblings across 107 families.
• Reflux nephropathy was significantly higher in siblings presenting with UTI (26%) compared to asymptomatic screened siblings (7%).
• Mild renal damage was more prevalent in siblings with UTI (21%) than in screened siblings (2%), while moderate to severe damage showed no significant difference.

Conclusions:

• The incidence of mild renal scarring is significantly higher in siblings presenting with a urinary tract infection (UTI) compared to asymptomatic siblings.
• Moderate to severe renal scarring rates were comparable between symptomatic and asymptomatic siblings with VUR.
• Early detection and management of VUR in siblings, regardless of UTI history, are important for preventing renal damage.