Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux

Abstract

The incidence of vesicoureteral reflux (VUR) in the general population is less than 1%, but it is high in families with reflux. The reported prevalence of VUR among siblings of index patients with reflux has ranged from 4.7% to 51%. Reflux carries an increased risk of pyelonephritis and long-term renal impairment. The purpose of this study was to identify the age-related incidence and severity of reflux, and the frequency of associated renal parenchymal damage in siblings of children with reflux in order to assess the use of screening at different ages. Between October 1994 and February 2003, 40 siblings of 34 index patients were screened with direct voiding cystography. 99( m ) technetium (Tc)-dimercaptosuccinic acid (DMSA) nuclear renal scans were performed in siblings with VUR to detect renal scarring. The cystograms were interpreted as showing the presence or absence of VUR and the DMSA scan as symmetrical or asymmetrical differential function, with or without renal scarring. Of 40 siblings, 17 had VUR, representing an incidence of 42.5%. The mean age at study entry of the 15 boys and 25 girls was 63 months (range 6 months to 12 years). The majority of siblings with abnormal DMSA scans were asymptomatic. Reflux was unilateral in 12 siblings and bilateral in 5. Of the 17 refluxing siblings (22 refluxing ureters), 7 (41.17%) had a history of symptomatic urinary tract infection (UTI). The frequency of VUR was nearly equal in siblings over 6 years and those younger than 6 years. Of the 17 siblings with VUR, 16 had DMSA scintigraphy. Of these, 5 were normal and 11 (68.75%) showed abnormalities (7 asymmetrical differential function and 4 parenchymal defect), which was bilateral in 7 and unilateral in 4. In conclusion, this study confirms a significant overall incidence of VUR and renal parenchymal damage in the siblings of patients with known reflux. The prevalence of reflux in older siblings is similar to that in younger siblings. Our review suggests that all siblings over 6 years should undergo a screening cystogram, even in the absence of urinary tract infection. DMSA scintigraphy of asymptomatic siblings appears to be beneficial in preventing renal injury.

Nuclear Medicine in the First Year of Life

“…We have found that reflux severity in these asymptomatic children varies widely from mild to severe (68)(69)(70). The incidence of renal cortical damage in these siblings with VUR is high (68,(71)(72)(73)(74).…”

Vesicoureteral Reflux Incidence in Siblings of Children With Reflux: Is Screening Required?

“…The incidence of VUR in siblings in previous studies was reported as 27% by Wan et al (17) and 51% by Parekh et al (18). Hollowel and Greenfield (19) have found the incidence of VUR in siblings as 32% in their study and the incidence was found 42.5% by Ataei et al (20).…”

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

“…5,6 But in some recent studies from America and Europe showed that the incidence was much higher and it was 17-70% in children with UTI. [2][3][4]7 On the other hand the incidence is much lower(7%) in west African descendents. 8 There are no controversy regarding association of VUR, UTI and renal scarring.…”