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The current status of screening for vesicoureteral reflux
1Department of Urology, LeBonheur Children's Medical Center, Memphis, Tennessee, USA.
Insights
Early screening for reflux nephropathy in siblings and offspring of affected individuals is crucial. This approach significantly reduces renal damage by detecting reflux before urinary tract infections occur.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Reflux nephropathy is a leading cause of end-stage renal disease and severe hypertension in children.
- Early detection of reflux is vital to prevent kidney damage, ideally before urinary tract infections (UTIs).
Purpose of the Study:
- To evaluate the effectiveness of screening high-risk populations (siblings and offspring of known refluxers) for reflux.
- To determine optimal screening strategies for early detection and prevention of renal damage.
Main Methods:
- Focused screening efforts on siblings and offspring of individuals diagnosed with reflux.
- Compared renal damage rates in screened siblings versus index patients.
- Modified screening recommendations for older siblings and offspring based on study findings.
Main Results:
- High rates of reflux were identified in both sibling and offspring groups.
- Early detection of reflux in siblings led to significantly lower rates of renal damage compared to index patients.
- Study results informed updated screening recommendations for these at-risk populations.
Conclusions:
- Screening siblings and offspring of known refluxers is an effective strategy for early diagnosis.
- Timely intervention based on early reflux detection can prevent or mitigate renal damage.
- Targeted screening in these high-risk groups is essential for managing pediatric reflux nephropathy.
Abstract:
Reflux nephropathy is responsible for a significant percentage of end-stage renal disease in late childhood as well as being the most common cause of severe hypertension in childhood and adolescence. To prevent reflux nephropathy, it is imperative to discover reflux at the youngest age possible and preferably before any urinary tract infections have occurred. Since screening of the general population for reflux is not feasible, we have focused our efforts on the siblings of known refluxers and, more recently, the offspring of known refluxers. We have found high rates of reflux in both groups and have shown in the sibling population that early discovery of sibling reflux has significantly lowered the rate of renal damage compared with the index patients. It is imperative to screen these two risk populations at the youngest age possible, but we have recently made modifications in our recommendations for the older sibling and offspring. The results of these two screening studies are given as well as our current recommendations for screening for reflux in these risk groups.