Vesicoureteric reflux and urinary tract infection in children

Abstract

An association between vesicoureteric reflux (VUR) and renal damage was found in 1960. In 1973, the term reflux nephropathy (RN) was first used to describe the renal damage caused by VUR. Follow up studies show that about 10%-20% of children with RN develop hypertension or end stage renal disease. It is now evident that there is a sex difference in the development of RN. In most males with RN, the kidneys are congenitally abnormal. In females it is an acquired condition, the most severe damage being sustained by recurrent urinary tract infections (UTIs). The purpose of current UTI guidelines is to identify VUR or any other abnormality of the urinary tract. Since the advent of routine antenatal ultrasonography, there is no longer a need to identify an abnormality of the urinary tract after the first reported UTI. Routine investigations are not required. Recurrent UTIs and a family history of VUR need further evaluation. There is also an urgent need to establish the long term value of prophylactic antibiotics in children with VUR.

Usefulness of parametric renal clearance images in the assessment of basic risk factors for renalnal clearance images in the assessment of basic risk factors for renal scarring in children with recurrent urinary tract infections

“…Incidence of renal scars in children with UTI, according to the literature, varies between about 20% and 80% [2,4,21,22]. This fact should be probably attributed to various methodological assumptions, different structures of studied material of patients in relation to race, age, sex, duration time of UTI, and above all incidence and number of clinically documented APNs -a basic etiological factor of cortical scars.…”

“…It is believed, however, that low degree VUR does not provide a significant risk factor for renal scarring [4,[24][25][26].…”

“…Higher tendency to renal parenchyma infections and formation of renal scarring is also correlated with urine outflow disturbances. Vesico-uretheral reflux (VUR) of higher grade forms a documented risk factor for this scarring [4,5].…”

Extravesical Seromuscular Ureteroneocystostomy: An Effective and Simple Operation for Treatment of Vesicoureteral Reflux

“…Reflux nephropathy (RN) may be the most common cause of childhood hypertension. Follow-up studies show that about 10-20% of children with RN develop hypertension or end-stage renal disease [3] .…”

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

“…Over time, substantial scarring may lead to long-term complications such as hypertension, proteinuria, renal failure which is collectively known as reflux nephropathy (RN). [1,2] Although early detection and management of VUR in these patients improve renal outcomes, RN is still a common cause of childhood end-stage renal disease (ESRD) in developing countries. Low socioeconomic status of patients, their parents' and healthcare personnel's insufficient awareness of urinary tract infection (UTI) and reflux, late referral to the pediatric urology and nephrology centers are considered as potential risk factors for RN in these regions.…”