Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the Italkid Project

Marra, Giuseppina; Oppezzo, C; Ardissino, Gianluigi; Daccò, Valeria; Testa, Sara; Avolio, Luigi; Taioli, Emanuela; Sereni, F; Project, on behalf of the ItalKid

doi:10.1016/j.jpeds.2004.01.043

Cited by 99 publications

(53 citation statements)

References 36 publications

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“…Reflux nephropathy is a cause of childhood hypertension and chronic renal failure. 3 Marra et al reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure, and found that those with VUR accounted for 26% of all children with chronic renal failure. The various treatment options currently available for VUR are: (1) long term antibiotic prophylaxis; (2) open surgical treatment; (3) minimally invasive endoscopic treatment; and (4) observation or intermittent therapy with management of bladder/bowel dysfunction (BBD) and treatment of UTI as they occur.…”

Section: Vur (J Pediatr 2012;-:---)mentioning

confidence: 99%

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Hunziker

Mohanan

D’Asta

et al. 2012

The Journal of Pediatrics

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Objective To evaluate the incidence of febrile urinary tract infection (UTI) after successful endoscopic correction of intermediate and high-grade vesicoureteral reflux (VUR).Study design Medical records of 1271 consecutive children (male, 411; female, 903) who underwent successful endoscopic correction of VUR were reviewed. Factors potentially influencing postoperative UTIs, such as history of presentation, age, sex, grade of VUR, renal scarring, and agent used for the endoscopic injection, were analyzed.Results Febrile UTI developed in 73 children (5.7%) after successful endoscopic correction of VUR. Thirty-nine children had a single episode of UTI, and 34 children had two or more episodes at 1 month to 5.9 years (median, 1 year) after correction of VUR. With multivariate analysis, female sex (P < .001), history of preoperative bladder/ bowel dysfunction (BBD; P = .005), and BBD after endoscopic correction (P = .001) were revealed to be the most important independent risk factors for a febrile UTI after successful correction of VUR. ConclusionsThe incidence of febrile UTIs after successful correction of intermediate and high grade VUR is low.Female sex and BBD were the most important risk factors in the development of febrile UTI. Our data supports the importance of assessing bladder and bowel habits in older children with febrile UTIs after endoscopic correction of VUR. (J Pediatr 2012;-:---).V esicoureteral reflux (VUR) is the most common urinary tract abnormality in pediatrics, occurring in 1% to 2% of children, including 30% to 40% of children with urinary tract infection (UTI). 1,2 The association of VUR, febrile UTI, and renal parenchymal damage is well recognized. Reflux nephropathy is a cause of childhood hypertension and chronic renal failure. 3 Marra et al reviewed data on children with chronic renal failure who had high-grade VUR in the Italkid project, a database of Italian children with chronic renal failure, and found that those with VUR accounted for 26% of all children with chronic renal failure. The various treatment options currently available for VUR are: (1) long term antibiotic prophylaxis; (2) open surgical treatment; (3) minimally invasive endoscopic treatment; and (4) observation or intermittent therapy with management of bladder/bowel dysfunction (BBD) and treatment of UTI as they occur.Since United States Food and Drug administration approval in 2001 of dextranomer hyaluronic acid (Dx/HA) as a tissue augmenting substance for subureteral injection, endoscopic treatment has become a widely accepted minimally invasive alternative in the management of VUR.The main goals of treatment of children with VUR are to prevent renal parenchymal damage and morbidity associated with recurrent febrile UTIs. Relatively few studies have examined the incidence of febrile UTIs after successful resolution of VUR with endoscopic injection. The duration of follow-up in most series has been short, with conflicting rates of incidence of UTI. Febrile UTIs after successful resolution of VUR have been reported a...

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Section: Vur (J Pediatr 2012;-:---)mentioning

confidence: 99%

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Hunziker

Mohanan

D’Asta

et al. 2012

The Journal of Pediatrics

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“…[9][10][11] Especially in girls, early detection and treatment of primary VUR following UTIs may preserve renal parenchyma, or at least, prevent its progression to ESRD during childhood. [11,12] The diagnosis and management of childhood primary VUR remains controversial. Imaging algorithms used to evaluate the children who experienced the first episode of fUTI depend on two approaches; bottom-up or top-down.…”

Section: Discussionmentioning

confidence: 99%

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Doğan

Koyun

Aksoy

et al. 2018

Turkish Journal of Urology

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Objective: In this study, we aimed to assess renal outcomes of delayed diagnosis of dilating primary vesicoureteral reflux (VUR) following recurrent febrile urinary tract infections (fUTIs) and its diagnostic imaging procedures. Material and methods:The medical records of patients who underwent ultrasonography (US), non-acute dimercaptosuccinic acid (Tc-99mDMSA) scintigraphy and voiding cystourethrography (VCUG), and who were older than 2 years at the time of VUR diagnosis were retrospectively reviewed.Results: A total of 32 children (female, n=27: 84.4%) with a mean age of 7.67±3.34 years at the time of diagnosis of VUR were included in the study. Grade III, IV, V VUR were found in 22%, 69%, and 9% of the patients, respectively. At the time of VUR diagnosis, abnormal US findings were detected in 75% of the cases. Tc-99mDMSA detected abnormalities in 83.9% (7 with a single scar, 7 with multiple lesions, 12 with reduced kidney function) of the patients. Estimated glomerular filtration rate of 3 patients with bilateral grade IV VUR was <75 mL/min/1.73 m 2 . In 5 patients (16%), VUR could not be predicted by US+DMSA scintigraphy (Grade IV VUR in 3 and Grade III in 2 cases ). The sensitivity in predicting VUR was 75.00% , respectively, for US alone and combined US+DMSA. Conclusion:VCUG should be performed routinely in addition to US and non-acute DMSA in all children referred with recurrent fUTIs. Awareness of childhood UTI in public and healthcare personnels should be increased in order to refer these patients at a early stage to pediatric urology and nephrology units.

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“…reports regarding gender distribution of vur patients vary. 10,14,16,21,[30][31][32][33] However, other authors have observed that the male:female ratio in children with reflux is dynamic across different age groups, ranging from a male preponderance in infants to a clear female preponderance in older children. 30,34 it is also important to recognize that the calculated ratio between the sexes is dependent upon the method of ascertainment.…”

Section: Vur Is a Complex Diseasementioning

confidence: 99%

“…with the widespread use of prenatal ultrasound, it has become evident that a substantial number of infants who go on to be diagnosed with vur have congenital renal damage. [8][9][10] Congenital reflux nephropathy occurs as a result of abnormal embryological development with subsequent renal dysplasia, and is largely seen in male infants with high-grade vur. exposure to utis in patients with congenital renal dysplasia can lead to progression of renal parenchymal damage.…”

Section: Introductionmentioning

confidence: 99%

“…12 Furthermore, despite improvements in diagnosis and treatment of vur, reflux nephropathy is still recognized as an important cause of childhood hypertension and chronic renal failure. 10,13 the familial nature of vur is well established. Familial clustering of vur has been described by several groups, with a prevalence of between 27% and 51% in siblings of index patients with vur, [14][15][16][17] and a 66% rate of vur in children whose parents had reflux.…”

Section: Introductionmentioning

confidence: 99%

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Genetics of vesicoureteral reflux

et al. 2011

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| Primary vesicoureteral reflux (VUR) is the most common urological anomaly in children, affecting 1-2% of the pediatric population and 30-40% of children presenting with urinary tract infections (UTIs). Refluxassociated nephropathy is a major cause of childhood hypertension and chronic renal failure. The hereditary and familial nature of VUR is well recognized and several studies have reported that siblings of children with VUR have a higher incidence of reflux than the general pediatric population. Familial clustering of VUR implies that genetic factors have an important role in its pathogenesis, but no single major locus or gene for VUR has yet been identified and most researchers now acknowledge that VUR is genetically heterogeneous. Improvements in genome-scan techniques and continuously increasing knowledge of the genetic basis of VUR should help us to further understand its pathogenesis.

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Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the Italkid Project

Cited by 99 publications

References 36 publications

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Incidence of Febrile Urinary Tract Infections in Children after Successful Endoscopic Treatment of Vesicoureteral Reflux: A Long-Term Follow-Up

Delayed diagnosis of primary vesicoureteral reflux in children with recurrent urinary tract infections: Diagnostic approach and renal outcomes

Genetics of vesicoureteral reflux

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