Risk factors identified for renal abnormality in vesicoureteral reflux

Researchers have identified the main risk factors for renal functional abnormalities in children with high-grade (grade 4-5) vesicoureteral reflux (VUR).

Age over 1 year and the presence of grade 5 VUR were the main risk factors in a study of 774 children with the condition. In addition, children with a history of bladder/bowel dysfunction (BBD) were at a greater risk for renal functional abnormalities than those without.

One of the major goals of treating a child with VUR is the prevention of recurring urinary tract infections (UTIs) and prevention of renal parenchymal injury, explain Prem Puri (Our Lady's Children's Hospital, Dublin, Ireland) and team. However, "guidelines for the management of reflux nephropathy do not exist and the true extent of reflux nephropathy and its clinical course are unknown," they say.

As reported in the Journal of Urology, 291 (38%) of the children had renal abnormalities on dimercaptosiccinic acid scans, including 29 children with bilateral scarring. The abnormalities were present in 240 (34%) of 698 children who had grade 4 VUR and 51 (67%) of 76 who had grade 5 VUR.

Multivariate analysis showed that children aged older than 1 year had a 3.45-fold greater risk for renal functional abnormalities than younger children. And children who had grade 5 versus grade 4 reflux had an almost 6 times greater risk for developing the abnormalities.

"Our study confirmed that older children with high grade VUR had a higher risk of renal functional abnormalities," says the team "These older children may have had unrecognized recurrent UTIs leading to renal scar formation."

Additionally, the presence of renal functional abnormalities was significantly lower among children who presented with UTI or BBD than among children who had not had a UTI.

The team says previous studies have suggested that appropriate management of BBD, such as treating constipation and ensuring frequent and complete voiding is important to prevent recurrent UTIs and possibly prevent further renal injury. "Our findings confirm that BBD is a predictor of renal functional abnormalities."

The researchers conclude that early detection and treatment of high grade VUR may prevent acquired renal parenchymal damage and limit progression of renal damage in congenital reflux nephropathy.

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