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Prevalence and Clinical Features of Vesicoureteral Reflux in Children With Recurrent Urinary Tract Infections: A
Niloufar Peirovi1,2, Neda Pak3, Mastaneh Moghtaderi1
1Pediatric Chronic Kidney Disease Research Center, Gene, Cell & Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences Tehran Iran.
Insights
Vesicoureteral reflux (VUR) affects over half of children with recurrent urinary tract infections (UTIs), often presenting as mild, unilateral cases. Early detection and management of VUR and voiding dysfunction are crucial for preventing kidney damage in children.
Area of Science:
- Pediatric Nephrology
- Urology
- Congenital Anomalies
Background:
- Vesicoureteral reflux (VUR) is a common congenital anomaly in children presenting with urinary tract infections (UTIs).
- VUR can lead to severe complications such as renal scarring and permanent kidney damage.
- Understanding VUR prevalence and associated factors in recurrent UTIs is critical for timely intervention.
Purpose of the Study:
- To determine the prevalence, laterality, and severity of VUR in children with recurrent UTIs.
- To investigate associations between VUR and demographic, clinical, and functional factors.
- To inform strategies for preventing kidney damage in pediatric patients.
Main Methods:
- A cross-sectional study involving 109 children (2 months to 5 years) with recurrent UTIs.
- Data collection included VUR grade and laterality, renal scarring, constipation, voiding dysfunction, and gender.
- Statistical analysis to identify significant associations.
Main Results:
- Vesicoureteral reflux (VUR) was present in 51.38% of children with recurrent UTIs.
- Unilateral reflux and mild-to-moderate grades (1-3) were predominant.
- Voiding dysfunction was highly prevalent (66.1%) and significantly associated with VUR; 30.2% had renal scarring.
Conclusions:
- The prevalence of VUR in children with recurrent UTIs is higher than previously reported.
- Female gender, voiding dysfunction, and VUR are interconnected in pediatric recurrent UTIs.
- Early detection and management, including addressing bladder-bowel dysfunction, are vital to prevent renal damage.
Background And Aims:
Vesicoureteral reflux (VUR) is one of the most common congenital anomalies in children with urinary tract infections (UTIs), potentially leading to serious complications, including renal scarring and permanent kidney damage. This study aimed to assess the prevalence, laterality, and severity of VUR and its associations with demographic, clinical, and functional factors in children with recurrent UTIs.
Methods:
This cross-sectional study examined 109 children aged 2 months to 5 years with recurrent UTIs who were referred to a tertiary center of nephrology clinic. Data collected included age at diagnosis, renal scarring, constipation, voiding dysfunction, gender, VUR grade, and laterality.
Results:
Of the 109 children studied, 51.38% had VUR (unilateral or bilateral). The majority of patients were female (78.9%). Unilateral reflux (29.35%) was more frequent than bilateral reflux (22.01%). Among those with VUR, 58.9% had mild to moderate reflux (grades 1-3), while 41.07% had severe reflux (grades 4-5). Renal parenchymal scarring was present in 30.2% of cases, more commonly affecting the right kidney (18.3%) than the left (4.6%). Voiding dysfunction was highly prevalent (66.1%) and was significantly associated with VUR. Most patients (85.3%) received antibiotic prophylaxis, although its association with renal scarring was not statistically significant.
Conclusion:
This study identified a higher prevalence of VUR among children with recurrent UTIs than previously reported, with unilateral and mild-to-moderate reflux being predominant. The findings highlight the interplay between female gender, voiding dysfunction, and VUR in recurrent pediatric UTIs. Early detection and targeted management, including addressing bladder-bowel dysfunction and judicious use of antibiotic prophylaxis, are essential to prevent recurrent infections and reduce the risk of renal damage.
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