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Functional assessment of renal damage in children with primary vesicoureteral reflux
Yaju Zhu1, Yufeng Li1, Jing Jin1
1Department of Pediatric Nephrology, Rheumatology and Immunology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
Insights
Children with primary vesicoureteral reflux (VUR) show impaired renal function, particularly in the refluxing kidney. Bilateral VUR significantly reduces total effective renal plasma flow (ERPF) compared to controls.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Primary vesicoureteral reflux (VUR) is a common congenital anomaly in children.
- VUR can lead to urinary tract infections (UTIs) and potentially cause renal damage.
- Early detection and evaluation of renal function are crucial for managing VUR.
Purpose of the Study:
- To assess renal function damage in children diagnosed with primary VUR.
- To identify correlations between VUR characteristics and the extent of renal impairment.
Main Methods:
- Retrospective analysis of 226 children with VUR and 85 UTI controls.
- Evaluation of age at diagnosis, body weight, renal ultrasound findings, VUR grade, serum creatinine, dimercaptosuccinic acid (DMSA) scans, and effective renal plasma flow (ERPF).
Main Results:
- Children with bilateral VUR had significantly lower total ERPF than controls.
- Unilateral VUR also showed reduced ERPF compared to controls.
- Split renal function, assessed by DMSA, was impaired in refluxing kidneys (28.00% left, 29.12% right) versus controls (40.27%).
- Renal damage correlated with VUR grade, transverse diameter, and pyelectasis.
Conclusions:
- Split renal function is compromised in the affected kidney in children with VUR.
- Total ERPF is lower in bilateral VUR compared to unilateral VUR.
- VUR grade, transverse diameter, and pyelectasis are significant indicators of renal damage.
Objectives:
To evaluate the renal function damage in children with primary vesicoureteral reflux (VUR).
Methods:
A total of 226 children with VUR (65 cases with left, 39 with right, and 122 cases with bilateral VUR) were screened. Eighty-five urinary tract infection (UTI) cases, without urinary malformations, during the same period were collected as controls. Age at diagnosis, body weight, renal ultrasound, VUR grade, serum creatinine level, dimercaptosuccinic acid (DMSA) level, and effective renal plasma flow (ERPF) values were retrospectively analyzed.
Results:
There were no significant differences in age at diagnosis between study groups. Total ERPF was significantly lower in the bilateral VUR group than in the control group. The ERPF in unilateral VUR was significantly lower than that in the contralateral or ipsilateral side in the control group (P < 0.001). The mean split renal function, as assessed by DMSA of VUR, was 28.00% and 29.12% on the left and right sides, respectively, both of which were lower than the control group's 40.27%. Renal damage was also correlated with a VUR grade (P = 0.008), a transverse diameter (P = 0.002), and pyelectasis (P = 0.037).
Conclusion:
Split renal function was impaired in the reflux kidney. The total ERPF in the bilateral VUR group was lower than that in the unilateral VUR group. Renal damage was correlated with a VUR grade, a transverse diameter, and pyelectasis.
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