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Vesicoureteral reflux and reflux nephropathy in children
1Division of Pediatric Nephrology, Children's Hospital of Philadelphia, PA 19104.
Insights
Vesicoureteral reflux (VUR) affects many children with urinary tract infections and can lead to kidney damage. Identifying at-risk children through noninvasive studies is crucial for early intervention.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Urology
Background:
- Vesicoureteral reflux (VUR) is a significant factor in pediatric urinary tract infections (UTIs).
- Reflux nephropathy is a leading potentially reversible cause of end-stage renal disease in children and adults.
- The pathogenesis of reflux nephropathy requires further elucidation despite extensive research.
Purpose of the Study:
- To highlight the diagnostic challenges in reflux nephropathy.
- To emphasize the need for identifying children with dysfunctional voiding.
- To advocate for the use of noninvasive studies in at-risk pediatric populations.
Main Methods:
- Review of existing literature on VUR and reflux nephropathy.
- Analysis of findings from the International Reflux Study in Children (1992).
- Discussion of diagnostic approaches for identifying children at risk.
Main Results:
- The 1992 International Reflux Study showed no clear advantage for surgical versus medical management in high-grade VUR over 5 years.
- Newer surgical techniques may offer improved outcomes.
- Dysfunctional voiding remains a critical area for identification in children with VUR.
Conclusions:
- Early identification of children at risk for VUR and its complications is essential.
- Noninvasive diagnostic studies are recommended for children with antenatally diagnosed hydronephrosis and siblings of those with known VUR.
- Further research into the pathogenesis and optimal management of reflux nephropathy is warranted.
Abstract:
Vesicoureteral reflux is seen in up to one half of all children with urinary tract infections and reflux nephropathy is potentially the leading reversible cause of end-stage renal disease in children and adults. Recent studies still leave some doubt to the pathogenesis of reflux nephropathy. In 1992, the International Reflux Study in Children published data on the 5-year follow-up of children with high-grade reflux showing no clear advantage toward either surgical or medical management (although new surgical techniques may prove beneficial). A need to identify children with dysfunctional voiding exists. Appropriate, preferably noninvasive, studies should be employed to identify children at risk including those with antenatally diagnosed hydronephrosis and siblings of children with documented reflux.