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Estimation of Renal Functional Reserve in Children with Different Grades of Vesicoureteric Reflux

Rafey Abdul Rahman1, Veereshwar Bhatnagar1, Sandeep Agarwala1

  • 1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Journal of Indian Association of Pediatric Surgeons
|April 24, 2018
PubMed

Insights

Renal functional reserve (RFR) is impaired in children with high-grade vesicoureteric reflux (VUR). RFR is preserved in low-grade VUR, indicating its importance in assessing kidney function in pediatric patients.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Nuclear Medicine

Background:

  • Vesicoureteric reflux (VUR) is a common pediatric urological anomaly.
  • Renal functional reserve (RFR) measures the kidney's capacity to increase glomerular filtration rate (GFR) after a stimulus.

Purpose of the Study:

  • To evaluate RFR in children with VUR using 99mTc diethylenetriamine pentaacetic acid (DTPA) for GFR estimation.
  • To assess the correlation between VUR grade and RFR.
  • To investigate the utility of DTPA-based GFR measurements in pediatric VUR assessment.

Main Methods:

  • RFR was estimated in 53 children with VUR (31 unilateral, 22 bilateral).
  • GFR was determined using a double compartment-2 sample method with 99mTc DTPA radioisotope.
  • Patients were subgrouped into low-grade (IA, IIA) and high-grade VUR (IB, IIB).

Main Results:

  • RFR was significantly lower in unilateral high-grade VUR (Group IB) compared to unilateral low-grade VUR (Group IA).
  • RFR was significantly lower in bilateral high-grade VUR (Group IIB) compared to unilateral low-grade VUR (Group IA).
  • Stimulated GFR strongly correlated with baseline GFR in both unilateral and bilateral VUR groups.

Conclusions:

  • RFR is impaired in children with high-grade unilateral and bilateral VUR.
  • RFR is relatively preserved in children with low-grade unilateral and bilateral VUR.
  • DTPA-based GFR estimation is a valuable tool for assessing RFR in pediatric VUR.
Abstract

Keywords:
99Tc diethylenetriamine pentaacetic acidglomerular filtration raterenal functional reservevesicoureteric reflux

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