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New development and progression of renal scarring in children with primary VUR
Insights
New kidney scarring in children with primary vesicoureteral reflux (VUR) occurred in 7.3% of cases. High-grade VUR, recurrent UTIs, and high-pressure reflux are key risk factors for scar development.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- Scarring can result from VUR and urinary tract infections (UTIs), potentially leading to kidney damage.
- Understanding scar progression is crucial for long-term patient outcomes.
Purpose of the Study:
- To investigate the incidence and progression of renal scarring in children with primary VUR.
- To identify risk factors associated with new scar formation or progression of existing scars.
- To determine the optimal follow-up duration for children with VUR.
Main Methods:
- Analysis of 711 children diagnosed with primary VUR.
- Evaluation of renal scarring development and progression over time.
- Correlation of scarring with VUR grade, UTI history, and bladder pressure.
Main Results:
- New renal scarring or progression of previous scarring was observed in 7.3% of kidneys with reflux.
- High-grade VUR, recurrent UTIs, and high-pressure reflux were identified as significant risk factors.
- The average age for new scar formation was between 7 and 9 years.
Conclusions:
- Continuous monitoring is essential for children with VUR, extending follow-up to age 15, even post-surgery.
- Early identification and management of risk factors can mitigate renal scarring.
- Understanding scar progression aids in predicting and preventing long-term renal complications.
Abstract:
To study the development of new scars and progression of previous scarring, we analysed 711 children with primary VUR. New scar or progression of previous scarring was observed in 7.3% of the kidneys with reflux. Factors which promote the formation of new scars are high-grade VUR, recurrent UTIs and high-pressure bladder which results in high-pressure reflux. The average age of new scarring was from 7 to 9 years. We emphasize the importance of the follow-up study until the age of 15 years, even after reflux has stopped following surgery.