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Renal damage in vesico-ureteric reflux
P Caione1, G Ciofetta, G Collura
1Division of Paediatric Urology, Department of Nephrology and Urology, Bambino Gesù Children's Hospital, Research Institute, Rome, Italy. caione@opbg.net
BJU International
|March 11, 2004
Summary
Vesico-ureteric reflux (VUR) often causes renal parenchymal damage, with reduced kidney function worsening with reflux severity. This study highlights VUR
Area of Science:
- Pediatric Nephrology
- Radiology
- Urology
Background:
- Primary vesico-ureteric reflux (VUR) is a common condition in children.
- Renal parenchymal damage is a significant complication of VUR.
- Understanding the patterns and extent of damage is crucial for management.
Purpose of the Study:
- To determine the extent of renal parenchymal involvement in primary VUR.
- To analyze the relationship between VUR grade, patient age, and patterns of renal damage.
- To evaluate renal function using 99mTc-DMSA scintigraphy.
Main Methods:
- Retrospective analysis of 197 children with primary VUR.
- Voiding cysto-urethrography (VCUG) and 99mTc-dimercaptosuccinic acid (DMSA) renal scintigraphy were performed.
- DMSA scans classified into single scar (SS), multiple scarring (MS), or diffuse reduced uptake with small renal size.
Main Results:
- 67% of refluxing units showed renal damage, compared to 16% of non-refluxing units.
- Absolute uptake (AU) decreased significantly with increasing VUR grade (P < 0.001).
- Severe VUR (grade 4-5) was associated with multiple scarring (MS) and reduced renal size, particularly in younger children (< 2 years).
Conclusions:
- VUR is frequently associated with renal parenchymal damage.
- Renal function (AU) declines progressively with VUR severity.
- Severe VUR leads to more extensive scarring and reduced kidney size, impacting function.