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Vesicoureteral reflux in children: incidence and severity in siblings
L P Connolly1, S T Treves, S A Connolly
1Department of Radiology (Division of Nuclear Medicine), Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Insights
The study found a high incidence of vesicoureteral reflux (VUR) in asymptomatic siblings, particularly in those under 24 months. Early screening is crucial to prevent potential renal damage in these children.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- Vesicoureteral reflux (VUR) is a condition where urine flows backward from the bladder to the kidneys.
- Identifying at-risk siblings is crucial for early intervention and prevention of kidney damage.
Purpose of the Study:
- To determine the incidence of VUR in asymptomatic siblings of children diagnosed with VUR.
- To assess the occurrence of renal damage in these asymptomatic siblings with VUR.
Main Methods:
- Retrospective review of 482 siblings (295 girls, 187 boys) aged 2 weeks to 12.8 years undergoing radionuclide cystography.
- Evaluation of ultrasonograms and renal cortical scintigrams for signs of reflux and renal damage.
- All siblings were asymptomatic at the time of referral.
Main Results:
- Overall VUR incidence was 36.5% (girls 39.3%, boys 32.1%).
- Incidence was highest in children ≤24 months (45.7%), with increased risk of bilateral reflux.
- Renal damage was observed in 4.7% of siblings with VUR, even without symptomatic urinary tract infections.
Conclusions:
- A significant incidence of VUR persists in siblings up to 72 months of age.
- Early screening of siblings is vital to detect VUR and prevent secondary renal damage.
- Renal damage can occur in asymptomatic children with VUR, highlighting the importance of screening.
Purpose:
We attempted to determine the incidence of vesicoureteral reflux in asymptomatic siblings of children with reflux at different ages and assess the incidence of renal damage in asymptomatic siblings with reflux.
Materials And Methods:
We reviewed radionuclide cystograms of 482 consecutively referred siblings of children with vesicoureteral reflux, including 295 girls and 187 boys 2 weeks to 12.8 years old (mean age 2.8 years). Ultrasonograms and renal cortical scintigrams of children with reflux were evaluated. All siblings were considered asymptomatic by the referring physicians.
Results:
The overall incidence of vesicoureteral reflux was 36.5%, and the incidence in girls and boys was 39.3 and 32.1%, respectively. Children 24 months old or younger had the highest incidence (45.7%) and the highest risk of bilateral reflux. From ages 25 to 72 months the incidence of reflux was 33.1% and in siblings older than 72 months it was 7%. Reflux of urine to the level of the renal pelvis was detected in 28.6% of all referred siblings. Renal damage was observed on sonography or scintigraphy in 4.7% of the siblings with reflux.
Conclusions:
The high incidence of vesicoureteral reflux through age 72 months indicates that it is important to screen siblings of children with reflux at an early age to prevent renal damage, which can occur in the absence of symptomatic urinary tract infection.