Alternative Approaches to the Prognostic Stratification of Mild to Moderate Primary Vesicoureteral Reflux in Children

Sciagrà, Roberto; Materassi, Marco; Rossi, Vania; Ienuso, Rita; Danti, Alfredo; Cava, Guiseppe La

doi:10.1097/00005392-199606000-00084

Cited by 9 publications

(11 citation statements)

References 12 publications

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“…The prevalence of VUR in children with UTI varies among different racial groups. Studies in the USA, the UK, and Italy showed the highest prevalence of VUR (41-63%) [3][4][5]. The lowest reported prevalence of VUR in children with UTI was in Black American children (6-12%) and in Jamaican children (10%) [6,7].…”

Section: Discussionmentioning

confidence: 95%

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The relationship between urinary tract infections and vesicoureteral reflux in Turkish children

et al. 2008

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Early determination of renal scar development risk in children following first urinary tract infection (UTI) and early detection and treatment of vesicoureteral reflux (VUR) are important to prevent renal functional impairment. The aim of this study was to determine the prevalence of VUR and associated renal scar formation, in children who had acute pyelonephritis (APN), first afebrile UTI, and recurrent afebrile UTIs. Patient records of 642 children having UTI were scrutinized and 278 out of 642 were enrolled in this study. The patients were divided into three groups: Group 1, patients with APN (n = 73); Group 2, patients with the first afebrile UTI (n = 88); and group 3, patients with recurrent afebrile UTIs (n = 117). Among these groups, VUR prevalence did not differ significantly (group 1: 24.6%, group 2: 22.7%, and group 3: 26.4%. Renal scarring was detected in 19.3% of the patients and was remarkably lower in group 2 when compared with the other two groups (P < 0.05). Renal scarring was found in 37.1% of the patients with VUR, whereas it was found in 14.3% of patients without VUR. Renal scarring incidence was remarkably higher in patients with grades 4-5 VUR (61.5%) compared with those with grades 1-3 VUR (30.6%) (P = 0.055). In conclusion, since VUR was demonstrated in as many as one-quarter of patients with the first afebrile UTI and VUR incidence did not differ significantly among the groups, all UTIs, lower and upper ones, should be carefully evaluated.

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Section: Discussionmentioning

confidence: 95%

“…Several studies have shown that radiological abnormalities exist in as many as 25-55% of children after their first UTI, with one-third having VUR [4][5][6][7][8][9][10]. There was a high incidence of acute pyelonephritis (APN) in the presence of VUR, but APN does not necessarily need VUR for its development.…”

Section: Introductionmentioning

confidence: 99%

The relationship between urinary tract infections and vesicoureteral reflux in Turkish children

et al. 2008

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“…Studies from the United States, United Kingdom, and Italy showed the highest prevalence of VUR (41%-63%) [3,9,10]. In other countries with a predominately Caucasian population (Sweden and Australia), the prevalence is lower (24%-27%) [11,12].…”

Section: Discussionmentioning

confidence: 96%

Vesicoureteric reflux in Kuwaiti children with first febrile urinary tract infection

et al. 2003

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The prevalence of vesicoureteric reflux (VUR) in children with urinary tract infection (UTI) varies among different racial groups. The purpose of this study was to determine the frequency of VUR and associated renal changes in a group of Arab Kuwaiti children with their first documented febrile UTI and to compare our findings with those reported from other racial groups. One hundred and seventy-four children (38 males and 136 females) fulfilled the study criteria and were divided into three age groups (<1 year, 1-5 years, and >5 years). Patients in each group had both micturating cystourethrography (MCUG) and 99m-Tc-dimercaptosuccinic acid (DMSA) renal scan after diagnosis. VUR was detected in 39 children (22%). Two-thirds of cases had mild reflux (grade I and II). Females ( n=32) had more reflux than males ( n=7) (24% vs. 18%). Sixty-three patients (36%) had abnormal (DMSA) renal scans (acute pyelonephritis [AP] or renal scars). Of these, 79% were children below 5 years. Abnormal DMSA scans were found in 4 of 38 males (11%) versus 59 of 136 females (43%). Abnormal scans in children with VUR were seen in 1 of 7 males (14%) versus 19 of 32 females (59%). In total, the combination of abnormal scan with VUR occurred in 1 of 38 males (3%) and in 19 of 136 females (14%), whereas abnormal scan without demonstrable VUR was seen in 3 of 38 males (8%) versus 40 of 136 females (29%). Our data showed that the frequency of VUR in Arab Kuwaiti children with febrile UTI is midway between Caucasian and other racial groups. In this study, males had a lower-risk profile than females, the latter having a higher rate of reflux as well as a higher rate of abnormal DMSA scans, irrespective of demonstrable VUR.

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“…UU., el Reino Unido e Italia, y las tasas más bajas varían entre el 6% y el 12% en los niños afroamericanos y son del 10% en los niños jamaiquinos. 3,[11][12][13][14] En nuestro país, en un estudio con 300 pacientes, Yılmaz y col. determinaron que la tasa de RVU era del 30,9%. 15 En el estudio actual, se observó que la tasa de RVU coincidía con la bibliografía relevante y que era estadísticamente significativa cuando se analizaron los grupos por separado.…”

Section: Discussionunclassified

Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias

2018

Arch Argent Pediatr

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Arch Argent Pediatr 2018;116(4):e542-e547 / e542Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias Conflicto de intereses:Ninguno que declarar.Recibido: 19-10-2017 Aceptado: 19-2-2018 RESUMEN Introducción. El objetivo del estudio fue investigar la relación entre reflujo vesicoureteral (RVU) y daño renal en pacientes con infección urinaria (IU) sin fiebre, primera IU febril e IU recurrente. El objetivo secundario, determinar si la proteína C-reactiva (PCR) actuaría como predictor de nefroesclerosis en las IU febriles. Población y métodos. Estudio prospectivo; pacientes pediátricos con IU sin fiebre, primera IU febril e IU recurrente. Los análisis de laboratorio de rutina incluyeron hemograma completo, urea, creatinina, análisis de orina completamente automatizado, urocultivo y PCR. Se realizó ecografía urológica luego del diagnóstico de IU, cistouretrografía miccional tras seis semanas y gammagrafía renal estática con ácido dimercaptosuccínico marcado con 99mTc tras seis meses a todos los participantes. Resultados. Participaron 47 niños con IU sin fiebre, 48 con primera IU febril y 61 con IU recurrente. Hubo una diferencia estadísticamente significativa entre los grupos respecto de RVU y nefroesclerosis (p= 0,001 y p= 0,011, respectivamente). También hubo una diferencia estadísticamente significativa respecto de nefroesclerosis entre los pacientes con y sin RVU (p= 0,001). Además, se estableció una diferencia estadísticamente significativa respecto de nefroesclerosis (p < 0,05) en los pacientes con PCR cinco veces mayor o menor que el valor de corte aceptado (5 mg/dl). Conclusión. La proporción de nefroesclerosis fue paralela a la frecuencia de RVU. Cuanto mayor era el grado de RVU, mayor era el daño renal. Se determinó una correlación positiva entre PCR elevada y nefroesclerosis, lo que señala esclerosis durante el diagnóstico de pielonefritis. INTRODUCCIÓNLas infecciones urinarias, en especial en los niños menores de t r e s a ñ o s , s e e n c u e n t r a n e n t r e las infecciones bacterianas más frecuentes. 1 En el 10% al 64% de los casos de pielonefritis aguda (PA) se notifica daño del parénquima renal, con casos de pacientes con infección recurrente y tratamiento inadecuado que presentan riesgos de morbilidad, tales como hipertensión e insuficiencia renal crónica (IRC). 2 El reflujo vesicoureteral (RVU) es la anomalía detectada con más frecuencia en los pacientes pediátricos con infección urinaria (IU), con una incidencia del 30% al 50%, mientras que se observa nefroesclerosis en el 30% al 40% de los pacientes. 3,4 Por lo tanto, es necesario estudiar cada caso de IU pediátrica para determinar la presencia de RVU. A c t u a l m e n t e , l a g a m m a g r a f í a con ácido dimercaptosuccínico (dimercaptosuccinic acid, DMSA) es la mejor técnica de diagnóstico por imágenes disponible para detectar lesiones renales asociadas con la pielonefritis aguda. 5 Se ha informado que la lesión renal detectada por g a m m a g r a f í a c o n D M S A e n e l transcurso de una p...

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Alternative Approaches to the Prognostic Stratification of Mild to Moderate Primary Vesicoureteral Reflux in Children

Cited by 9 publications

References 12 publications

The relationship between urinary tract infections and vesicoureteral reflux in Turkish children

The relationship between urinary tract infections and vesicoureteral reflux in Turkish children

Vesicoureteric reflux in Kuwaiti children with first febrile urinary tract infection

Asociación entre el reflujo vesicoureteral y la nefroesclerosis en las infecciones urinarias

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