Related Experiment Videos
[Renal scars in children with primary vesicoureteral reflux]
Célia S Macedo1, Márcia C Riyuzo, Herculano D Bastos
1Departamento de Pediatria, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil. pediatri@fmb.unesp.br
Insights
Fever and female sex are key risk factors for renal scars in children with primary vesicoureteral reflux. Early diagnosis is crucial to prevent scarring, as delayed detection correlates with higher scar incidence.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Primary vesicoureteral reflux (VUR) is a common condition in children.
- Renal scarring can lead to long-term complications, including hypertension and renal insufficiency.
- Identifying risk factors for renal scarring is essential for timely intervention.
Purpose of the Study:
- To determine the incidence of renal scars in children with primary VUR.
- To analyze the influence of sex, age, febrile urinary infection, reflux grade, and bacterial species on renal scar development.
- To identify risk factors associated with renal scarring in pediatric VUR.
Main Methods:
- Retrospective study of 58 children diagnosed with primary VUR via voiding cystourethrogram after urinary tract infection.
- Renal scarring assessed using dimercaptosuccinic acid (DMSA) scans.
- Follow-up DMSA scans were performed in a subset of patients.
Main Results:
- The overall incidence of renal scarring was 55.2%.
- Renal scars were significantly more common in girls (77.6%) and children presenting with fever.
- Fever (OR=6.19) and female sex (OR=4.12) were identified as significant risk factors for renal scarring.
- Delayed diagnosis was associated with a higher prevalence of renal scars.
Conclusions:
- Fever and female sex are significant risk factors for renal scars in children with primary VUR, particularly with dilated reflux.
- The high incidence of renal scars suggests a potential link to delayed diagnosis of VUR.
- Prompt diagnosis and management of VUR are critical to minimize renal damage.
Objective:
To determine the incidence of renal scars in children with primary vesicoureteral reflux taking into consideration the following variables: sex, age at diagnosis, febrile urinary infection, degree of reflux and bacteria specimen.
Method:
Retrospective study of 58 children with age ranging from 2 months to 11 years, presenting primary vesicoureteral reflux detected by voiding cystourethrogram after documented episode of urinary tract infection. The diagnosis of renal scarring was obtained by dimercaptosuccinic acid scan 5 months after the treatment of the urinary infection; in 40 children the dimercaptosuccinic acid scan was performed again from 6 months up to 6 years after the treatment.
Results:
45 children (77.6%) were girls and 13 (22.4%) were boys, 51.7% were 2 years old or younger. The incidence of renal scarring was 55.2%. There was significant higher proportion of renal scars in girls, when the patients presented fever and dilated vesicoureteral reflux (III, IV, V). Fever and female sex were risk factors for the development of renal scars (fever--ODDS ratio=6.19 and female sex--ODDS ratio=4.12). There was a prevalence of renal scars in children over 2 years old. The interval between the beginning of the symptoms and the first medical visit was longer in the children with renal scars. New renal scars were observed in 12.5%.
Conclusions:
Fever and female sex were risk factors for the presence of renal scars, mainly in the dilated vesicoureteral reflux. The high incidence of renal scars in this study may be related to delayed diagnosis of vesicoureteral reflux.
Related Concept Videos
01:22Imaging Studies V: Intravenous Urography and Retrograde Pyelography
01:24Esophageal Varices-I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:28Urinary Tract Calculi V: Nursing Management
01:22Imaging Studies VI: Voiding Cystourethrography and Cystography
01:26Nursing Assessment of the Genitourinary System II: Inspection and Palpation