Predictors of renal scar in children with urinary infection and vesicoureteral reflux

Abstract

We evaluated the predictors of renal scar in children with urinary tract infections (UTIs) having primary vesicoureteral reflux (VUR). Data of patients who were examined by dimercaptosuccinic acid (DMSA) scintigraphy between 1995 and 2005 were evaluated retrospectively. Gender, age, reflux grade, presence/development of scarring, breakthrough UTIs, and resolution of reflux, were recorded. The relation of gender, age and VUR grade to preformed scarring and the relation of gender, age, VUR grade, presence of preformed scarring, number of breakthrough UTIs and reflux resolution to new scarring were assessed. There were 138 patients [male/female (M/F) 53/85]. Multivariate analysis showed that male gender [odds ratio (OR) 2.5], age > or = 27 months in girls (OR 4.2) and grades IV-V reflux (OR 12.4) were independent indicators of renal scarring. On the other hand, only the presence of previous renal scarring was found to be an independent indicator for the development of new renal scar (OR 13.4). In conclusion, while the most predictive variables for the presence of renal scarring among children presenting with a UTI were male gender, age > or = 27 months in girls, and grades IV-V reflux, the best predictor of new scar formation was presence of previous renal scarring.

Association of Vesicoureteric Reflux (VUR) in Children with Symptomatic Urinary Tract Infection (UTI) - in a Tertiary Care Hospital, Dhaka, Bangladesh

“…2 Similar result was found by Zaki et al 31 In our study, the incidence and severity of grades of VUR in children is higher than the studies done by Chand et al and Zaki et al 2,31 The lack of antenatal sonologic evaluation and late referral of the patients are the two important risk factors that differs the present study with others. 32,33 In our study grade III-V reflux was present in 31 renal units which comprises 88.56% of the refluxing units .This figure is much higher than the study by Orellana P et al where moderate to severe grades were present in43.16% kidneys. 32 The higher incidence of reflux with advanced grades in our study again reflects parental ignorance and late referral of the patients who ultimately reach at our center with advanced stage of the disease.…”

Predictors of abnormal renal cortical scintigraphy in children with first urinary tract infection: the importance of time factor

“…Biggi et al [18], Fernández-Menéndez et al [5] and Soylu et al [20] found an association between high grade VUR and an abnormal DMSA renal scan. Although VUR is a famous predisposing factor for the development of APN, some recent studies have questioned such predisposition.…”

Antireflux surgery does not change ongoing renal functional deterioration

“…Risk factors for renal scarring are VUR, UTI, and previous scar/dysplasia. 5,6 Although antenatal US can help identify up to 30% of newborns with VUR, exposing detectable renal damage prior to UTI, US imaging can miss detection of approximately half of the scars. In accordance with this data, US was normal in 44% of our patients with abnormal DMSA.…”

“…This result is in accordance with our previous data that the most important predictor of new/progressive scarring is the presence of renal scar. 6 Reflux nephropathy has been associated with longterm renal dysfunction like proteinuria and/or renal insufficiency. 7,9,10,14 Neither medical nor surgical treatment of VUR prevented renal function deterioration.…”