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Vesicoureteric reflux in children
Jameela A Kari1, Sherif M El-Desoky, Faten Basnawi
1Department of Pediatrics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
Insights
Children with primary vesicoureteric reflux (VUR) and normal bladders maintain good kidney function. Secondary VUR, linked to bladder issues like posterior urethral valves or spina bifida, often results in impaired kidney function.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Vesicoureteric reflux (VUR) is a common condition in children.
- Understanding the differences between primary and secondary VUR is crucial for management.
- Associated bladder abnormalities can significantly impact kidney health.
Purpose of the Study:
- To differentiate between primary and secondary VUR in children.
- To assess the impact of bladder abnormalities on kidney function in VUR patients.
- To evaluate the utility of dimercaptosuccinic acid (DMSA) scans in VUR assessment.
Main Methods:
- Retrospective review of medical records of 99 children with VUR.
- Analysis of radiological investigations and kidney function tests (creatinine levels).
- Statistical analysis using Chi-square and paired t-tests.
Main Results:
- Primary VUR (20.2%) showed normal kidney function; high-grade VUR was associated with renal scars (72%).
- Secondary VUR (79.8%) stemmed from posterior urethral valves (PUV), neurogenic bladder (meningomyelocele, non-neurogenic neurogenic bladder [NNB]), or prune belly syndrome.
- Children with secondary VUR and bladder abnormalities (NNB, meningomyelocele, PUV) presented with higher creatinine, but kidney function did not significantly worsen.
Conclusions:
- Primary VUR with a normal bladder is linked to good kidney function.
- Secondary VUR associated with bladder abnormalities (NNB, spina bifida, PUV) correlates with impaired kidney function.
- DMSA scans effectively predict high-grade primary VUR.
Aim:
This study aimed to identify the differences between primary and secondary vesicoureteric reflux (VUR) and the effect of associated bladder abnormalities on kidney function.
Patients And Methods:
We retrospectively reviewed the medical records of children with VUR who were followed up at King Abdulaziz University Hospital from January 2005 to December 2010. The review included results of radiological investigations and kidney function tests. We used Chi-square test for statistical analysis and paired t-test to compare group means for initial and last creatinine levels.
Results:
Ninety-nine children were included in this study. Twenty (20.2%) had primary VUR, 11 had high-grade VUR, while 9 had low-grade reflux. All children with low-grade VUR had normal dimercaptosuccinic acid (DMSA). Renal scars were present in 72% of the children with high-grade VUR. The mean creatinine levels (initial and last) for both groups were normal. Seventy-nine (79.8%) children had secondary VUR, which was due to posterior urethral valves (PUV) (46.8%), neurogenic bladder caused by meningomyelocele (25.3%), non-neurogenic neurogenic bladder (NNB) (21.5%), or neurogenic bladder associated with prune belly syndrome (6.3%). Children with NNB, meningomyelocele and PUV had high creatinine at presentation with no considerable worsening of their kidney functions during the last visit. Renal scars were present in 49.4% of the children with secondary VUR.
Conclusion:
Children with primary VUR and normal bladder had good-functioning kidneys, while those with secondary VUR associated with abnormal bladder caused by NNB, spina bifida or PUV had abnormal kidney functions. DMSA scans were useful in predicting higher grades of VUR in children with primary reflux.
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