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Published on: October 12, 2017
Prevalence and determinants of failure to thrive in children with vesico-ureteral reflux
Stefano Guarino1, Anna Di Sessa1, Maeva De Lucia1
1Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Naples, Italy.
Insights
Failure to thrive (FTT) affects less than 5% of children with vesico-ureteral reflux (VUR), often due to non-renal issues. Supplementation may aid growth in specific cases of urinary solute loss.
Area of Science:
- Pediatric Nephrology
- Growth Disorders
Background:
- Vesico-ureteral reflux (VUR) is a common condition in children.
- Failure to thrive (FTT) can be a complication of VUR, but its prevalence and causes require further investigation.
- Urinary solute losses may impact growth in children with VUR.
Purpose of the Study:
- To determine the prevalence and contributing factors of FTT in pediatric VUR patients.
- To evaluate the impact of supplementation on growth in VUR patients with urinary solute losses.
Main Methods:
- Retrospective analysis of 1277 VUR patients.
- Screening for renal tubular function impairment (TFI) in patients with FTT.
- Supplementation provided for FENa >2% or low bicarbonate levels.
Main Results:
- FTT prevalence was 4.4% (56/1277 patients).
- Extrarenal causes (75%) were the primary drivers of FTT, not recurrent UTIs (p=0.68).
- TFI was present in 16.1% of FTT patients; supplementation led to catch-up growth in some.
Conclusions:
- FTT is uncommon (<5%) in VUR patients and primarily linked to extrarenal factors.
- Recurrent UTIs do not significantly predict FTT in VUR.
- Supplementation with sodium and bicarbonates shows potential benefit for selected VUR patients with urinary solute losses.
Aim:
To assess the prevalence and determinants of failure to thrive (FTT) among patients with vesico-ureteral reflux (VUR) and evaluating the effects of supplementation on growth in patients with urinary solute losses.
Methods:
We retrospectively enrolled 1277 patients with VUR (mean age at diagnosis = 6.5 months). Patients with FTT were screened for renal tubular function impairment (TFI). If fractional excretion of sodium (FENa) >2% or blood bicarbonate <20 mmol/L, supplementation was provided.
Results:
Among 1277 patients, 56 (4.4%) had FTT. Of these, 42 (75%) presented extrarenal causes of FTT, 3 (5.4%) had chronic kidney disease (CKD), 9 (16.1%) had TFI, and 2 (3.5%) had CKD and TFI. FTT occurred in 8/208 patients (3.8%) with and in 48/1069 patients (4.5%) without (p = 0.68) recurrent urinary tract infections (UTIs). At multiple logistic regression, birthweight <10th percentile, preterm birth, TFI, identified or suspected syndromes and other diseases were predictors of FTT. Eleven (19.6%) patients with FTT had TFI; five with increased FENa and/or acidosis received supplementation and showed catch-up growth. The remaining six patients exhibited spontaneous catch-up growth.
Conclusion:
FTT was found in <5% of children with VUR. It was not determined by recurrent UTIs and was mainly associated with extrarenal causes. Supplementation with sodium and bicarbonates could be useful in selected cases.
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