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The RIVUR trial: a factual interpretation of our data

Tej K Mattoo1, Myra A Carpenter, Marva Moxey-Mims

  • 1Division of Pediatric Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201, USA, tmattoo@med.wayne.edu.

Pediatric Nephrology (Berlin, Germany)
|January 7, 2015
PubMed

Insights

Antimicrobial prophylaxis significantly reduced urinary tract infection (UTI) recurrences in children with vesicoureteral reflux (VUR). The RIVUR trial suggests a shift towards selective prophylaxis rather than no prophylaxis for these patients.

Area of Science:

  • Pediatric Nephrology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Vesicoureteral reflux (VUR) is a significant risk factor for recurrent urinary tract infections (UTIs) and potential renal scarring in children.
  • The RIVUR trial, a large randomized, placebo-controlled study, investigated antimicrobial prophylaxis in 607 children (aged 2-72 months) with VUR.
  • Key patient demographics included a median age of 12 months, 92% female, and 86% with a febrile index UTI.

Discussion:

  • Trimethoprim/sulfamethoxazole demonstrated a 50% reduction in UTI recurrences compared to placebo.
  • No significant difference in renal scarring was observed between prophylaxis and placebo groups in the RIVUR trial.
  • The study's design limitations mean it was not powered to definitively assess prophylaxis's role in preventing renal scarring.

Key Insights:

  • Antimicrobial prophylaxis is effective in reducing UTI recurrence in children with VUR.
  • The debate on VUR management should evolve from 'no prophylaxis' to 'selective prophylaxis'.
  • Bladder bowel dysfunction was noted in 56% of toilet-trained children, a factor potentially influencing UTI risk.

Outlook:

  • Further research is needed to refine criteria for selective antimicrobial prophylaxis in VUR.
  • Long-term outcomes regarding renal scarring require continued investigation in children with VUR.
  • Understanding the interplay between VUR, UTI, and bladder bowel dysfunction is crucial for optimal patient management.

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