Familial vesicoureteral reflux--is screening beneficial?

The familial nature of vesicoureteral reflux is well recognized. Screening siblings for reflux is controversial. We identified a group of siblings of index patients with vesicoureteral reflux who are most likely to be affected. We also identified risk factors for renal scarring.

Between 1998 and 2007 the parents of 215 index patients with grades III to V vesicoureteral reflux were asked permission to screen siblings younger than 6 years for reflux. The 251 siblings with reflux were divided into those who were diagnosed following a urinary tract infection and those who were screened. Siblings were also divided into those younger than 3 years and those 3 to 6 years old at diagnosis. Dimercapto-succinic acid scans were available in 172 index patients and in 180 siblings.

Of the 251 siblings with reflux 105 and 146 were diagnosed after a urinary tract infection and after screening, respectively. A total of 207 siblings (82.5%) were younger than 3 years and 44 (17.5%) were 3 to 6 years old. There were 79 symptomatic siblings (75.2%) younger than 3 years and 26 (24.8%) who were 3 to 6 years old. Of the screened siblings with reflux 128 (87.7%) were younger than 3 years and 18 (12.3%) were 3 to 6 years old. Renal scarring was seen in 35.5% of symptomatic siblings compared to 15% of screened siblings.

The incidence of sibling VUR is maximal in patients who are younger than 3 years. Reflux in symptomatic siblings who are younger than 3 years is usually high grade and associated with a higher incidence of renal scarring. We recommend screening all siblings who are younger than 3 years of index patients with grades III to V vesicoureteral reflux.