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Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Tej K Mattoo1, Russell W Chesney2, Saul P Greenfield2

  • 1Due to the number of contributing authors, the affiliations are provided in the Supplemental Material tmattoo@med.wayne.edu.

Clinical Journal of the American Society of Nephrology : CJASN
|November 12, 2015
PubMed

Insights

Antimicrobial prophylaxis did not prevent renal scarring in children with vesicoureteral reflux (VUR). Older children and those with a second urinary tract infection (UTI) had more scarring, particularly with high-grade VUR.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Infectious Diseases

Background:

  • Vesicoureteral reflux (VUR) is a condition in children that can lead to urinary tract infections (UTIs) and kidney damage.
  • Recurrent UTIs in children with VUR are a concern for potential renal scarring.

Purpose of the Study:

  • To evaluate the effectiveness of antimicrobial prophylaxis in preventing recurrent UTIs and renal scarring in children with VUR.
  • To analyze factors associated with renal scarring in pediatric VUR patients.

Main Methods:

  • A multicenter, randomized, placebo-controlled trial (RIVUR) involving 607 children aged 2-71 months with VUR.
  • Participants received trimethoprim-sulfamethoxazole or placebo for 2 years, with renal scarring assessed by DMSA scans.
  • Independent review of renal scans by blinded radiologists to evaluate scarring.

Main Results:

  • New renal scarring occurred in 6% of the prophylaxis group and 7% of the placebo group, with no significant difference.
  • Older children, those with a second UTI before enrollment, Hispanic children, and those with higher grades of VUR were more likely to have renal scarring.
  • Renal units with grade 4 VUR had significantly higher rates of new scarring compared to those with no VUR.

Conclusions:

  • Antimicrobial prophylaxis did not reduce the incidence of renal scarring in children with VUR.
  • Renal scarring is more prevalent in older children and those with a history of multiple UTIs.
  • High-grade VUR is a significant risk factor for both pre-existing and new renal scarring.
Abstract

Keywords:
anti-infective agentschildhumanskidneyrandom allocationreflux nephropathyrenal scarringtrimethoprim-sulfamethoxazole combination urinary tract infectionsvesico-ureteral reflux

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