Overlooked Factors Causing Renal Damage in Vesicoureteric Reflux!

Area of Science:

• Pediatric Nephrology
• Urology
• Medical Research

Background:

• Vesicoureteric reflux (VUR) is linked to recurrent and febrile urinary tract infections (RUTI/FUTI), renal scarring, and damage.
• Conventional treatments focus on infection prevention, but may overlook other contributing factors to renal damage.
• The interplay of obstruction, pressure, stasis, infection, and damage (OPSID) in VUR is not well-understood.

Purpose of the Study:

• To investigate the overlooked factors within the OPSID nexus associated with VUR that contribute to renal damage.
• To differentiate VUR types based on obstruction and stasis for targeted treatment.

Main Methods:

• Retrospective study of 170 renal units in 135 patients with secondary VUR.
• Classification of VUR into 'rise and fall' (raf_VUR, no obstruction) and 'rise and stasis' (ras_VUR, with ureterovesical junction obstruction).
• Utilized cystogram, urodynamic studies (UDS), and other renal function assessments; interventions included anticholinergics, DJ stenting, reimplantation, and bladder neck incision (BNI).

Main Results:

• 132 renal units had raf_VUR and 38 had ras_VUR.
• All patients with ureterovesical junction obstruction (UVJO) were treated successfully.
• 29 patients required BNI for high bladder pressure; all 135 patients prevented upstaging of chronic kidney disease (USCKD).

Conclusions:

• Differentiating VUR types (raf_VUR vs. ras_VUR) and addressing obstruction and high bladder pressure are crucial for preventing renal damage.
• Active management of obstructive VUR and high-pressure VUR, alongside infection control, can prevent RUTI/FUTI and subsequent renal damage.
• The OPSID nexus likely holds the key to understanding and managing VUR-induced renal damage, potentially applicable to primary VUR as well.