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Reflux nephropathy, urinary tract infection, and voiding disorders
1Division of Pediatric Nephrology, North Shore University Hospital, Manhasset, NY 11030, USA.
Current Opinion in Pediatrics
|April 1, 1995
Summary
Voiding dysfunction, not just vesicoureteral reflux (VUR), is a key cause of kidney damage in children. This condition can lead to urinary tract infections (UTIs) and renal scarring, even without VUR.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Urinary tract infections (UTIs), vesicoureteral reflux (VUR), and voiding disorders can cause significant renal damage.
- Recent advancements in diagnostic tools like 99mTc-dimercaptosuccinic acid renal scans, urodynamic testing, and antenatal sonography have improved understanding of these conditions.
Purpose of the Study:
- To review the interrelationship between UTIs, VUR, voiding dysfunction, and renal damage in children.
- To elucidate the role of voiding dysfunction as a primary driver of renal damage.
Main Methods:
- Review of current literature and diagnostic modalities.
- Analysis of the interplay between bladder pressures, VUR, UTIs, and renal scarring.
Main Results:
- Renal damage and scarring can occur during febrile UTIs even without VUR.
- Renal damage may be present at birth in infants with gross VUR, preceding UTI.
- High intravesical and voiding detrusor pressures, indicative of voiding dysfunction, are common in infants with VUR and symptomatic UTIs, even in the absence of VUR.
Conclusions:
- Voiding dysfunction is a significant risk factor for developing VUR and UTIs in children.
- Renal damage can occur due to voiding dysfunction independently of VUR or UTI.
- Voiding dysfunction predisposes children to bladder colonization, VUR, and subsequent renal damage.