Unilateral vesicoureteric reflux: Low prevalence of contralateral renal damage

• Published in: The Journal of pediatrics Vol. 138; no. 6; pp. 875 - 879
• Main Authors: Polito, Cesare, Rambaldi, Pier Francesco, Mansi, Luigi, Di Toro, Rosario, La Manna, Angela
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.2001; Elsevier
• Subjects: Biological and medical sciences; Child, Preschool; Female; Humans; Kidney Diseases - diagnostic imaging; Kidney Diseases - etiology; Male; Medical sciences; Nephrology. Urinary tract diseases; Prevalence; Radionuclide Imaging; Urinary system involvement in other diseases. Miscellaneous; Urinary Tract Infections - complications; Urinary tract. Prostate gland; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - diagnostic imaging; SK; VUR; GR; UTI; FD; Human; Kidney disease; Urinary system disease; Urinary tract disease; Review; Scintigraphy; Statistics; Ascending pyelonephritis; Infection; Antibiotic; Vesicoureteral reflux; Pyelonephritis; Risk factor; Renal failure; Bladder disease; Inheritance(genetics); Child; Public health
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/mpd.2001.114336

Objective: We assessed the risk for the occurrence of renal damage in children with vesicoureteric reflux (VUR). Study design: We reviewed the records of 187 consecutive children, aged 3.8 ± (SD) 2.8 years, with unilateral primary VUR diagnosed after urinary tract infection (UTI). Dimercaptosuccinic acid renal scintigraphy was performed 4 to 6 months after the last UTI. Three patterns of renal damage were identified: global reduction (GR) of renal radionuclide uptake (20% to 40% of relative uptake), focal defects (FD) in uptake, and shrunken (relative uptake <20%) kidney (SK). We assumed that in these subjects FD indicated postpyelonephritic damage and that GR indicated congenital renal damage. Results: Scintigraphic renal damage of any type was present in 36.9% of the refluxing and in 3.2% of the nonrefluxing kidneys (odds ratio [OR], 17.6; 95% CI, 7.4 to 41.9). FD were present in 15.5% and 2.7% (OR, 6.7; CI, 2.5-17.6), GR in 19% and 0.5% (OR, 44.3; CI, 6.1 to 327.2), and SK in 6.9% and 0%, respectively. Patients with severe VUR showed a higher probability of renal damage than those with nonsevere VUR. Conclusions: In children with UTI and VUR, the refluxing kidney is most at risk of both congenital and acquired renal damage, and this risk increases with severity of reflux. (J Pediatr 2001;138:875-9)