Incidence of Post-Pyelonephritic Renal Scarring: A Meta-Analysis of the Dimercapto-Succinic Acid Literature

Faust, William; Diaz, Mireya; Pohl, Hans G.

doi:10.1016/j.juro.2008.09.039

Cited by 137 publications

(80 citation statements)

References 14 publications

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“…Children with VUR and UTI are nearly 4 times more likely to have a renal scar in refluxing units than those with pyelonephritis and no reflux. 13,16 Risk factors for renal functional abnormalities in siblings were associated with a history of a previous UTI, high-grade VUR, and age .1 year. Our study showed that the prevalence of renal damage in screened siblings without previous UTI was 15%, whereas it was 34% in siblings with a previous UTI.…”

Section: Discussionmentioning

confidence: 99%

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

2014

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WHAT'S KNOWN ON THIS SUBJECT:The familial nature of vesicoureteral reflux (VUR) is well recognized. Several studies have shown that siblings of children with VUR are at much higher risk for reflux than the general pediatric population with a reported prevalence between 26% and 50%. WHAT THIS STUDY ADDS:There is increased risk of renal cortical abnormalities in siblings with a previous urinary tract infection, siblings with high-grade VUR, and siblings .1 year of age. This information may be useful when counseling parents about the risk of familial VUR. abstract OBJECTIVE: Screening siblings of index patients with vesicoureteral reflux (VUR) has been proposed to identify children who are at risk for renal damage. However, screening siblings for VUR remains controversial. We investigated the prevalence of VUR and renal cortical abnormalities in the sibling population in a large cohort of families with VUR.METHODS: Between 1998 and 2012, parents of index patients with grade III to V VUR were asked permission to screen siblings ,6 years of age for VUR. Siblings were divided into 2 groups: siblings with a documented history of a previous urinary tract infection (UTI) and siblings who were screened for VUR and never had a UTI. A logistic regression model was used to determine independent risk factors associated with renal cortical abnormalities such as history of presentation, age, gender, and grade of VUR.RESULTS: There were 318 siblings in 275 families in the study. VUR was found after screening in 190 (60%) siblings and after a UTI in 128 (40%). Multivariate analysis revealed that siblings who had a previous UTI (odds ratio: 3.38), siblings with high grade reflux (odds ratio: 3.62), and siblings over 1 year of age (odds ratio: 2.84) were the most significant independent risk factors associated with renal cortical abnormalities. CONCLUSIONS:There is increased risk of renal cortical abnormalities in siblings with a previous UTI, siblings with high-grade VUR, and siblings over age 1 year. This information may help to counsel parents about the risk of VUR and reflux nephropathy in familial VUR. Pediatrics 2014;133:e933-e937 AUTHORS:

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Section: Discussionmentioning

confidence: 99%

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

2014

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“…Children with VUR grades 3 or higher have a higher risk of renal scarring compared with those with lower grades (RR, 2.1; 95% CI, 1.4 to 3.2) (3). In another systematic review, Faust et al (4) reported odds ratios (ORs) of 2.8 (95% CI, 1.9 to 4.2) and 3.7 (95% CI, 1.3 to 11.1) for renal scarring after APN in children with VUR and renal units with refluxing ureters, respectively. The authors concluded that children with VUR have an increased risk of renal scarring (4).…”

Section: Introductionmentioning

confidence: 99%

“…In another systematic review, Faust et al (4) reported odds ratios (ORs) of 2.8 (95% CI, 1.9 to 4.2) and 3.7 (95% CI, 1.3 to 11.1) for renal scarring after APN in children with VUR and renal units with refluxing ureters, respectively. The authors concluded that children with VUR have an increased risk of renal scarring (4). Renal scarring associated with VUR is also known as reflux nephropathy (RN).…”

Section: Introductionmentioning

confidence: 99%

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Mattoo¹,

Chesney²,

Greenfield³

et al. 2016

Clinical Journal of the American Society of Nephrology

106

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Background and objectives The main objectives of the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial were to evaluate the role of antimicrobial prophylaxis in the prevention of recurrent urinary tract infection (UTI) and renal scarring in children with vesicoureteral reflux (VUR). We present a comprehensive evaluation of renal scarring outcomes in RIVUR trial participants.Design, setting, participants, & measurements This multicenter, randomized, placebo-controlled trial enrolled 607 children aged 2-71 months with grade 1-4 VUR diagnosed after a first or second febrile or symptomatic UTI. Study participants received trimethoprim-sulfamethoxazole or placebo and were followed for 2 years. Renal scarring was evaluated by baseline and follow-up 99m technetium dimercaptosuccinic acid (DMSA) renal scans that were reviewed independently by two blinded reference radiologists.Results At the end of the study, 58 (10%) of 599 children and 63 (5%) of 1197 renal units had renal scarring. New renal scarring did not differ between the prophylaxis and placebo groups (6% versus 7%, respectively). Children with renal scarring were significantly older (median age, 26 versus 11 months; P=0.01), had a second UTI before enrollment (odds ratio [OR], 2.85; 95% confidence interval [95% CI], 1.38 to 5.92), were more likely to be Hispanic (OR, 2.22; 95% CI, 1.13 to 4.34), and had higher grades of VUR (OR, 2.79; 95% CI, 1.56 to 5.0). The proportion of new scars in renal units with grade 4 VUR was significantly higher than in units with no VUR (OR, 24.2; 95% CI, 6.4 to 91.2).Conclusions Significantly more renal scarring was seen in relatively older children and in those with a second episode of febrile or symptomatic UTI before randomization. Preexisting and new renal scars occurred significantly more in renal units with grade 4 VUR than in those with low-grade or no VUR. Antimicrobial prophylaxis did not decrease the risk of renal scarring.

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“…cases of febrile UTI and high-degree VUR. On the other hand, the incidence of renal scarring ranges from 15% to 62% (9)(10)(11)(12)(13) . In the present review, the authors' have not found in the Brazilian literature any study aimed at determining the prevalence of APN and incidence of renal scarring in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

“…Most studies utilize renal scintigraphy with DMSA for the diagnosis of such conditions. A meta-analysis considering studies related to DMSA scintigraphy has demonstrated an average of 46% of development of renal scarring after occurrence of APN, with a variation of 26% to 62%, depending upon the region of the planet (11) . In the cases of high-degree VUR and febrile urinary tract infection (UTI), 90% of the patients will present with APN (12) .…”

Section: Introductionmentioning

confidence: 99%

Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário

et al. 2013

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Tc-DMSA renal scintigraphy in a university hospital in Rio Grande do Sul between 2006 and 2009 were reviewed to investigate acute pyelonephritis/renal scarring. Additionally, the presence of vesicoureteral reflux, early use of antibiotics, and comorbidities were investigated on electronic records. The sample size calculation was based on a systematic review study and obtained a minimum of 147 patients. Patients whose electronic records were not available were excluded. Results: One hundred and fifty-seven children met the inclusion criteria; among them 48 had acute pyelonephritis and 8 of these had renal scars. Neither age nor sex presented any significant association with acute pyelonephritis (p = 0.405 and p = 0.124, respectively). No statistical significance was observed in the association between vesicoureteral reflux and acute pyelonephritis (p = 1.0) and other comorbidities (p = 0.470), and in relation to early use of antibiotics with acute pyelonephritis (p = 0.130) and renal scarring (p = 0.720). Conclusion: The frequencies found in the present study for acute pyelonephritis/renal scarring are in agreement with the results reported by most studies in the literature. Keywords: Pyelonephritis; DMSA; Scar.Objetivo: Calcular as frequências de pielonefrite aguda e cicatriz renal em pacientes menores de dois anos com cintilografia renal com 99m Tc-DMSA com primeiro quadro de infecção do trato urinário em hospital universitário brasileiro, comparando com dados da literatura internacional. Materiais e Métodos: Foram revisados laudos cintilográficos de crianças menores de dois anos de idade que realizaram cintilografia renal com 99m Tc-DMSA em um hospital universitário no Rio Grande do Sul, entre 2006 e 2009, para pesquisa de pielonefrite aguda/cicatriz renal. Revisaram-se a presença de refluxo vesicoureteral, o uso precoce de antibiótico, e a presença de comorbidades que constassem nos prontuários eletrônicos. Calculou-se a amostra com base num estudo de revisão sistemática e obteve-se um mínimo de 147 pacientes. Excluíram-se pacientes sem registro eletrônico. Resultados: Cento e cinquenta e sete crianças preencheram critérios de inclusão do estudo, 48 tiveram pielonefrite aguda e 8 destas apresentaram cicatriz renal. Nem a idade nem o gênero dos pacientes apresentaram associação significativa com pielonefrite aguda (p = 0,405 e p = 0,124, respectivamente). Não houve diferença estatística nas associações de refluxo vesicoureteral e pielonefrite aguda (p = 1,0) e outras comorbidades (p = 0,470) e em relação ao uso precoce de antibiótico com pielonefrite aguda (p = 0,130) e cicatriz renal (p = 0,720). Conclusão: As frequências de pielonefrite aguda e cicatriz renal obtidas concordam com os resultados da maioria dos estudos publicados. Unitermos: Pielonefrite; DMSA; Cicatriz. Berdichevski EH, Mattos SG, Bezerra S, Vilas ER, Baldisserotto M. Prevalence of acute pyelonephritis and incidence of renal scarring in children under the age of two with urinary tract infection evaluated by 99m Tc-DMSA renal scintigraphy: the...

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Incidence of Post-Pyelonephritic Renal Scarring: A Meta-Analysis of the Dimercapto-Succinic Acid Literature

Cited by 137 publications

References 14 publications

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial

Prevalência de pielonefrite aguda e incidência de cicatriz renal em crianças menores de dois anos de idade com infecção do trato urinário avaliadas por cintilografia renal com 99mTc-DMSA: a experiência de um hospital universitário

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