Reflux nephropathy and hypertension

Goonasekera, Chulananda; Dillon, Michael J.

doi:10.1038/sj.jhh.1000653

Cited by 24 publications

(9 citation statements)

References 110 publications

(119 reference statements)

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“…[23] The decline in renal function after valve ablation is accompanied by activation of RAS reflected in a gradual rise in PRA. Therapy with angiotensin converting enzyme-inhibitors stabilizes and then improves renal function, thereby, retarding the pace of renal damage.…”

Section: Discussionmentioning

confidence: 99%

Posterior urethral valve: Prognostic factors and renal outcome

Bhadoo

Bajpai

Panda

2014

J Indian Assoc Pediatr Surg

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Objective:The aim was to study the outcome of posterior urethral valve (PUV) cases treated by stepladder protocol and the prognostic factors affecting the outcome.Materials and Methods:Hospital records of all PUV patients treated by stepladder protocol between January 1992 and December 2013 were reviewed. The studied parameters were: Age at presentation, serum creatinine, types of surgical intervention, vesicoureteral reflux (VUR) on initial voiding cystourethrogram (VCUG), renal cortical scars, plasma renin activity (PRA), and glomerular filtration rate (GFR).Results:Of 396 PUV patients treated during the study period, 152 satisfied study criteria. The age at presentation ranged from 2 days to 15 years (mean 31.3 months). The mean follow-up period was 5 years (range: 2-18 years). Primary endoscopic valve ablation was the most common initial procedure. Chronic renal failure was seen in 42.7% patients at the last follow-up. Serum creatinine at presentation, initial PRA levels, initial GFR, and PRA levels at last follow-up were significant predictors of final renal outcome. Age at presentation (<1 vs. >1 year), presence/absence of VUR on initial VCUG and renal cortical scars had no significant correlation with ultimate renal function.Conclusion:Our study confirms the high prognostic significance of initial serum creatinine, PRA levels and GFR in cases with PUV. PRA also holds promise in long-term follow-up of these patients as a marker of progressive renal damage.

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Section: Discussionmentioning

confidence: 99%

Posterior urethral valve: Prognostic factors and renal outcome

Bhadoo

Bajpai

Panda

2014

J Indian Assoc Pediatr Surg

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“…[13] In such patients activation of RAS has been documented, of which PRA is one such manifestation. [14] Clinical and experimental evidence accumulating over the last decade convincingly suggests that RAS is a key player in the complex mechanisms of CRF. [1516] Renin is released from juxtaglomerular cells, which cleaves angiotensinogen, produced in the liver to generate Angiotensin I (ANG I).…”

Section: Discussionmentioning

confidence: 99%

Plasma renin activity: An early marker of progressive renal disease in posterior urethral valves

Bajpai

Singh

2013

J Indian Assoc Pediatr Surg

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Introduction:A significant number of children with posterior urethral valves (PUV) develop chronic renal failure (CRF) due to activation of the renin angiotensin system (RAS). We investigated the role of plasma renin activity (PRA) in these cases and sought to establish a relationship between the accepted criteria of renal damage and PRA.Aims and Objectives:The aim of this study is to establish the relationship between PRA and CRF.Materials and Methods:The records of 250 patients with PUV were reviewed. Multiple linear regression analysis was used to assess correlations between PRA, grade of reflux, presence of scars and raised creatinine and decrease in glomerular filtration rates (GFR). A P < 0.5 was considered as significant.Results:A total of 58 patients were included. Their mean age was 16 years, range 5.3-24.2 years, mean follow-up period was 12.6 ± 3.6 years. At diagnosis, 22/58 (38%) patients were in CRF and 36/58 (62%) patients had normal renal function (RF). The mean PRA after treatment was higher in those who developed CRF than in those with normal RF (12.6 ± 10.2 vs. 34.6 ± 14.2 ng/ml/24 h, P = 0.02). Mean GFR at 1 year of age were 48 ± 9.8 ml/min/1.73 m2 and 86 ± 12.5 ml/min/1.73 m2 respectively (P = 0.005). PRA correlated negatively with GFR, t = –2.816,Confidence Interval:P = 0. 007. In the temporal plot over a period of 14 years, a rise in PRA preceded the fall in GFR in patients who developed CRF.Conclusions:This study shows that RAS is activated earlier in kidneys susceptible to damage. PRA could be investigated as a marker for the early detection and prevention of ongoing renal damage.

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“…Urinary tract infections in children may cause focal renal parenchymal scarring, sometimes leading to hypertension and renal failure 1 2. Evidence that urinary tract infections can cause renal scars rapidly in animals with vesicoureteric reflux and intrarenal reflux may also be relevant in children aged less than 4 years 3 4.…”

Section: Introductionmentioning

confidence: 99%

A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial

Coulthard

Vernon²,

Lambert³

et al. 2003

BMJ

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Objectives To determine whether a nurse led education and direct access service improves the care of children with urinary tract infections. Design Prospective cluster randomised trial. Setting General practitioners in the catchment area of a UK paediatric nephrology department. Participants 88 general practices (346 general practitioners, 107 000 children). Main outcome measures Rate and quality of diagnosis of urinary tract infection, use of prophylactic antibiotics, convenience for families, and the number of infants with vesicoureteric reflux in whom renal scarring may have been prevented. Results The study practices diagnosed twice as many urinary tract infections as the control practices (6.42 v 3.45/1000 children/year; ratio 1.86, 95% confidence interval 1.42 to 2.44); nearly four times more in infants (age < 1 year) and six times more in children without specific symptoms. Diagnoses were made more robustly by study practices than by control practices; 99% v 89% of referred patients had their urine cultured and 79% v 60% had bacteriologically proved urinary tract infections (P < 0.001 for both). Overall, 294 of 312 (94%) children aged under 4 years were prescribed antibiotic prophylaxis by study doctors compared with 61 of 147 (41%) by control doctors (P < 0.001). Study families visited hospital half as much as the control families. Twice as many renal scars were identified in patients attending the study practices. Twelve study infants but no control infants had reflux without scarring. Conclusion A nurse led intervention improved the management of urinary tract infections in children, was valued by doctors and parents, and may have prevented some renal scarring.

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Reflux nephropathy and hypertension

Cited by 24 publications

References 110 publications

Posterior urethral valve: Prognostic factors and renal outcome

Posterior urethral valve: Prognostic factors and renal outcome

Plasma renin activity: An early marker of progressive renal disease in posterior urethral valves

A nurse led education and direct access service for the management of urinary tract infections in children: prospective controlled trial

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