Impact of early screening for reflux in siblings on the detection of renal damage

Area of Science:

• Pediatric Nephrology
• Urology
• Diagnostic Imaging

Background:

• Vesico-ureteric reflux (VUR) is a condition where urine flows backward from the bladder to the ureters.
• Screening siblings of affected children can identify VUR early, potentially before urinary tract infections (UTIs) or renal scarring occur.
• However, sibling screening may also detect clinically insignificant VUR, raising questions about the optimal screening strategy.

Purpose of the Study:

• To evaluate the impact of screening siblings of children diagnosed with significant VUR and renal scarring.
• To determine if early VUR detection in siblings prevents renal damage.
• To compare the incidence and severity of VUR and renal scarring in index patients and their screened siblings.

Main Methods:

• A cohort of 123 children, including index patients and their siblings, were screened using a standardized protocol.
• Voiding cystography was performed to diagnose VUR, and renal scarring was assessed via ultrasonography and renal scintigraphy.
• Clinical characteristics, VUR grades, and renal damage incidence were compared between index patients and siblings.

Main Results:

• VUR was detected in 36% of screened children. Of these, 61% had VUR grade < III and 39% had grade ≥ III; 48% had bilateral VUR.
• Among siblings with VUR, 70% had normal renal ultrasonography, including 32% with VUR grade ≥ III.
• Siblings screened after age two had a twofold increased risk of renal damage on scintigraphy compared to those screened earlier (P = 0.04).

Conclusions:

• Early screening (≤ 2 years) of asymptomatic siblings for VUR is more effective in preventing renal damage than screening older children.
• Proactive screening in young, asymptomatic siblings can identify VUR before it becomes clinically significant, thus preserving renal health.
• This strategy supports early intervention to mitigate long-term renal complications associated with VUR.