Reflux Nephropathy In Children Research Articles

The Role of Urinary NGAL in the Management of Primary Vesicoureteral Reflux in Children.

Vesicoureteral reflux (VUR) is the most frequent congenital urinary tract malformation and an important risk factor for urinary tract infections (UTIs). Up to 50% of children with VUR may develop reflux nephropathy (RN), and the diagnosis and monitoring of renal scars are invasive and costly procedures, so it is paramount to find a non-invasive and accurate method to predict the risk of renal damage. Neutrophil gelatinase-associated lipocalin (NGAL) has already proven to be a good predictive biomarker in acute kidney injuries, but there are few studies that have investigated the role of NGAL in primary VUR in children. Our aim is to review the predictive value of urine NGAL (uNGAL) as a non-invasive biomarker of RN in children with primary VUR, as well as its ability to predict the evolution of chronic kidney disease (CKD). Based on our analysis of the available original studies, uNGAL can be an accurate and reliable biomarker of RN and its progression to CKD. Some studies suggested a good correlation between VUR severity and uNGAL levels, but other studies found no significant correlation. The relationship between VUR severity and uNGAL levels is likely complex and influenced by factors such as UTIs, the timing of the urine sample collection, and the age and overall health of the patient.

Prevalence of Microalbuminuria and Its Association with Severe Urinary Reflux and Renal Scarring with Reflux Nephropathy in Children Aged Less Than 12 Years in Ilam, Iran

Background: Vesicoureteral reflux is a common urinary tract abnormality, which could damage the renal parenchyma. The present study aimed to investigate the prevalence of microalbuminuria and its association with the severity of urinary reflux and renal scarring with reflux nephropathy in children aged less than 12 years referred to Imam Khomeini Hospital in Ilam, Iran. Methods: This longitudinal study was conducted during one year on the hospitalized patients who had tested positive for urine and urine culture. After the treatment of urinary tract infection and obtaining a negative urine culture, isotope cystography or radiographic cystography was performed to diagnose urinary reflux. Data analysis was performed in SPSS version 20 using descriptive statistics, chi-square, and correlation-coefficients. Results: The prevalence of microalbuminuria in Ilam province was 35.7%. No significant difference was observed between the rates of microalbuminuria and reflux (P > 0.05). However, the inverse correlation in this regard was not considered significant (P > 0.05). A direct correlation was observed between the rate of microalbuminuria and the incidence and severity of scars, which was considered significant (P < 0.05). Conclusions: According to the results, the mean rate of microalbuminuria in reflux decreased with the increased degree of reflux. Due to the changes in microalbuminuria compared to the severity of urinary reflux, this method cannot be used to determine the severity of reflux, which it could be considered an influential factor and a method used for the early diagnosis and follow-up of patients and preventing final kidney damage and renal failure.

Prevalence of reflux nephropathy in Iranian children with solitary kidney: results of a multi-center study

BackgroundGiven the importance of the function of the remnant kidney in children with unilateral renal agenesis and the significance of timely diagnosis and treatment of reflux nephropathy to prevent further damage to the remaining kidney, we aimed to determine the prevalence of reflux nephropathy in this subgroup of pediatric patients.MethodsIn general, 274 children referred to pediatric nephrologists in different parts of Iran were evaluated, of whom 199 had solitary kidney and were included in this cross-sectional study. The reasons for referral included urinary tract infection (UTI), abnormal renal ultrasonography, being symptomatic, and incidental screening. Demographic characteristics, including age and gender were recorded. History of UTI and presence of vesicoureteral reflux (VUR) were evaluated.ResultsOf the 274 children evaluated in this study with the mean age (SD) of 4.71 (4.24) years, 199 (72.6%) had solitary kidney. Among these, 118 (59.3%) were male and 81 (60.7%) were female, 21.1% had a history of UTI, and VUR was present in 23.1%. The most common cause of referral was abnormal renal ultrasonography (40.2%), followed by incidental screening (21.1%), being symptomatic (14.1%), and UTI (5.5%). In 116 children (58.3%), the right kidneys and in 83 (41.7%) the left kidneys were absent. Besides, 14.6% of the participants had consanguineous parents and 3% had a family history of solitary kidney. Upon DMSA scan, the single kidney was scarred in 13.1%, of which only 7.5% were associated with VUR. In addition, proteinuria and hematuria were observed in 6.5% and 1.5% of children, respectively.ConclusionsThe prevalence of reflux nephropathy was 7.5% in children with solitary kidney with a male predominance. Given the relatively high prevalence of reflux nephropathy in these children, screening for VUR in the remnant kidney appears to be essential in this population.

Ранние маркеры развития и прогрессирования рефлюкс-нефропатии у детей

Ранние маркеры развития и прогрессирования рефлюкс-нефропатии у детей

MARKERS COLLAGENOPATHY AND SCLEROSIS IN THE DIAGNOSIS OF THE PROGRESSION OF REFLUX NEPHROPATHY IN CHILDREN

THE AIM. To reveal the informative indicators for the prediction of progression of reflux nephropathy in children with vesicoureteral reflux based on the study of the urinary excretion of markers of sclerosis (transforming growth factor-β 1 ), angiotensin II, procalcitonin, β 2 -microglobulin) and collagenopathy (peptidoglycans and free hydroxyproline). PATIENTS AND METHODS: the study group included 71 (52 girls) the patient at the age of 5.69±0.44 years with vesicoureteral reflux (VUR). Based on the results of DMSA-scintigraphy, all children were divided into 2 groups: the control group 9 children with VUR without foci of sclerosis and a study group included 62 patients with different degrees of reflux nephropathy (RN). The control group consisted of 20 healthy children at the age of 6.24 ± 0.31 years. In all children investigated the urinary excretion of AngII, TGF-β 1 , PCT, β 2 -MG, PSH and FH and counted it to the level of creatinine in the urine. RESULTS. Urinary levels of AngII, TGF-β 1 , PCT, β 2 -MG, PSH, and FH was significantly higher in groups of children with RN when compared with the control group. The highest level AngII, TGF-β 1 , PCT was defined in the main group (p<0.05). Patients with a severe degree of RN, the ><0.05). Patients with a severe degree of RN, thelevel of AngII, TGF-β 1 , PCT in urine was higher when compared with the control group and the group of children without foci of sclerosis (p<0.05). CONCLUSION. Installed direct correlation between the level of excretion AngII, TGF-β 1 , PCT and the severity of RN in patients with VUR indicates the feasibility and prospects of their inclusion as diagnostic markers predict the severity of reflux nephropathy.

Рефлюкс-нефропатия у детей: ранняя диагностика и мониторинг

Рефлюкс-нефропатия у детей: ранняя диагностика и мониторинг

Assessment of cystatin C and cystatin C-based GFR formulas in reflux nephropathy

ObjectiveEarly identification of reflux nephropathy (RN) could reduce the frequency of chronic kidney disease (CKD) caused by vesicoureteral reflux (VUR). We aimed to assess whether cystatin C has value for determining RN in children with VUR. Materials and methodsNinety-three children with VUR were classified into two groups according to the presence of renal parenchymal scarring (RS). Patients with RS were divided into three subgroups according to scar grade. Serum cystatin C, serum creatinine (Scr) and urine creatinine were measured. eGFR values of the patients were calculated with Scr-based, cystatin C-based and combined formulas. ResultsCystatin C was significantly higher in patients with RS than patients without RS and declined in parallel with grade of RS (p = 0.01). Scr was not significant in patients with and without RS. It was only significant between mild and severe scar subgroups (p < 0.05). All eGFR values were lower in RS (+) patients compared with RS (−) patients. All eGFR equations were negatively correlated with grade of RS (p < 0.05). ConclusionCystatin C could be a useful marker for identifying the risk and severity of RN in patients with VUR. Renal functions could be more accurately determined with Scr-cystatin C combined eGFR equations.

Approach to urinary tract infections.

Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.

Kidney length and scarring in children with urinary tract infection: importance of ultrasound scans

Many studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy is the most sensitive diagnostic method in the identification of irreversible renal lesions (scars) in children with previous episodes of acute pyelonephritis (APN). This study assessed the reliability of ultrasound in identifying reflux nephropathy in children with acute pyelonephritis with or without vesicoureteric reflux (VUR). Eighty children (45 female and 35 male, age range 5 months to 10 years, average age 2 years 1 month) with a positive history for at least one episode of APN participated in this study. All children underwent voiding cystourethrography, DMSA scintigraphy 4 to 8 months after the most recent episode of APN, and an ultrasound test evaluation less than 2 months after DMSA scintigraphy. Voiding cystourethrograms showed VUR in 52 children (68%); 13 of these were bilateral, for a total of 65 refluxing kidney units of the 154 (42%) evaluated; DMSA scintigram was normal for 108 of 154 kidneys (70%). Of the 65 kidneys with VUR, DMSA scintigram displayed normal findings in 29 cases (45%) and pathologic findings in 36 (55%). In the 79 nonrefluxing kidneys, DMSA scintigram was normal in 69 cases (87%). The relative risk of scarring in VUR kidneys is 2.6. The ultrasound study recorded a maximum longitudinal diameter between the 5th and 95th percentiles in 80 of 89 (81%) kidneys without VUR and in 21 of 65 (32%) with VUR. A significant correlation was found between maximum longitudinal diameters and DMSA scintigraphic findings in kidneys with VUR and those without VUR, respectively. This study establishes that ultrasound scans, by means of a simple and reproducible measurement technique, maximum longitudinal diameter, have a predictive value with regard to the presence of scars, with few exceptions. This finding, in our opinion, could lead to a decrease in the number of invasive procedures, in particular DMSA scan, in patients with APN.

Reflux nephropathy in children.

Reflux nephropathy in children.

Association of Angiotensin I Converting Enzyme Gene Polymorphism with Reflux Nephropathy in Children

Deletion polymorphism of angiotensin I converting enzyme (ACE) gene has been studied as a risk factor in various cardiovascular diseases and chronic nephropathies. Perturbation of local and systemic renin-angiotensin systems is one of the possible mechanisms of the progression of reflux nephropathy. In this study, the implication of ACE gene polymorphism in renal scarring and deterioration of renal function was analyzed in 66 children with vesicoureteral reflux. The genotype for the polymorphism was determined by PCR, and renal scar was identified by ^99mTc-DMSA renal scan. The allelic frequency of the deletion polymorphism showed no significant difference either between patients with normal renal function and those with decreased renal function or between patients with renal scar and those without. We conclude that deletion polymorphism of ACE gene, as an independent variable, is not associated with reflux nephropathy in children with vesicoureteral reflux.

Diagnosis of intrarenal reflux and its role in pathogenesis of reflux nephropathy in children.

We compared newly developed radionuclide cystography with conventional contrast voiding cystography (VCG) with regard to their diagnostic usefulness of intrarenal reflux (IRR) in children. Based on the imaging findings, we assessed the role of IRR in the pathogenesis of reflux nephropathy (RN). Among the ureters which revealed IRR diagnosed by radionuclide cystography, 38.9% (7 out of 18 ureters) of the cases examined by VCG had IRR. In the case of VCG, the sensitivity and specificity of IRR detection were 33.3% and 100%, respectively. There was a statistical correlation between the presence/absence of IRR and vesicoureteral reflux (VUR). RN was significantly correlated with advanced grade of VUR associated with IRR. Among 9 kidneys of the subjects who had suffered from urinary tract infection (UTI) only once, IRR was detected in 33.3% (3/9) and RN in 66.7% (2/3). From these findings, conventional contrast VCG is considered not effective for the diagnosis of IRR. Moreover, it is suggested that VUR complicated with IRR is deeply associated with the development of RN. In addition, it is suggested that UTI might be related to the onset of IRR.

Controversies in childhood urinary tract infections.

Management of childhood urinary tract infections is conceptually straightforward, but controversies persist. Specimens must be collected carefully or culture results can be difficult to interpret. Urine culture remains the diagnostic standard but does not substitute for careful urinalysis. Radiography studies are designed to define abnormalities predisposing patients to pyelonephritis and to assess the extent of renal involvement during infection, but there is no agreement on the most appropriate combination of studies. Circumcision reduces the incidence of urinary infections in male infants. Vaginal reflux may have an impact on recurrent infections, especially after courses of antibiotics. The importance of vesicoureteral reflux remains controversial because renal scarring appears to be related more to infection than to reflux itself. A strong argument can be made for the avoidance of prophylactic antibiotic therapy, even in patients with reflux. Increased attention to early diagnosis and treatment may be responsible for a decreasing incidence in renal failure from reflux nephropathy in children.

SUPPRESSION OF RENAL INFLAMMATION WITH VITAMINS A AND E IN ASCENDING PYELONEPHRITIS IN RATS

We evaluated the effects of vitamin A and E supplementation alone or in combination with non-steroidal anti-inflammatory drugs (NSAIDs) on the development of inflammation in an animal model of ascending pyelonephritis. Ascending pyelonephritis was induced in adult rats by surgical bladder inoculation with P-pili-forming Escherichia coli. Treatment of pyelonephritic rats was initiated at 72 hours post-infection. Treatment groups included no treatment, or a five day regimen of antibiotic only, antibiotic plus vitamins A and E, or antibiotic, vitamins and either of two NSAIDs. Kidneys were harvested at six weeks post-infection and assessed for histopathologic inflammation. Antibiotic treatment of pyelonephritic rats with vitamins A and E alone or in combination with NSAIDs resulted in significantly less kidney inflammation, as compared with untreated rats or rats treated with antibiotic alone. There was no significant difference in inflammation between animals treated with vitamins alone or vitamins plus NSAIDs. Antibiotic therapy and diet supplementation with vitamins A and E can significantly reduce the inflammation associated with ascending pyelonephritis, suggesting a potential use in the medical management of reflux nephropathy in children.

Voiding cystourethrography as a predictor of reflux nephropathy in children with urinary-tract infection.

Most children who develop renal damage (scarring) after urinary-tract infection have vesicoureteral reflux. Voiding cystourethrography is therefore usually recommended as the initial radiologic study in children with urinary-tract infection. However, renal damage may occur also in the absence of reflux. The aim of this investigation was to determine the sensitivity and predictive value of reflux during voiding cystourethrography in identifying children at risk for renal damage. Eighty-four consecutive children, 2 months to 6 years old, with nonobstructive, first-known, febrile urinary-tract infection underwent voiding cystourethrography and urography. Twenty-seven (32%) had reflux and 10 (12%) had or developed renal damage. Two of the children and four of the kidneys with renal damage had no reflux at initial examination. The sensitivity of reflux as a marker for renal damage was 80%, specificity was 74%, positive predictive value was 30%, and negative predictive value was 96%. Thus, most children who develop renal damage after urinary-tract infection have reflux during voiding cystourethrography. However, there is a risk, albeit small, for renal damage to occur in the absence of reflux.

Natural history of reflux nephropathy in children.

Natural history of reflux nephropathy in children.

Dysplastic Kidneys Associated with Vesicoureteral Reflux

No AccessJournal of UrologyPediatric Urology1 Sep 1973Dysplastic Kidneys Associated with Vesicoureteral Reflux John F. Stecker, John G. Rose, and Jay Y. Gillenwater John F. SteckerJohn F. Stecker More articles by this author , John G. RoseJohn G. Rose More articles by this author , and Jay Y. GillenwaterJay Y. Gillenwater More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)60211-8AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1973 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByShimada K, Matsui T, Ogino T, Arima M, Mori Y and Ikoma F (2018) Renal Growth and Progression of Reflux Nephropathy in Children with Vesicoureteral RefluxJournal of Urology, VOL. 140, NO. 5 Part 2, (1097-1100), Online publication date: 1-Nov-1988.Ambrose S, Parrott T, Woodard J and Campbell W (2018) Observations on the Small Kidney Associated With Vesicoureteral RefluxJournal of Urology, VOL. 123, NO. 3, (349-350), Online publication date: 1-Mar-1980.J.W.D. (2018) Editorial CommentJournal of Urology, VOL. 123, NO. 3, (350-351), Online publication date: 1-Mar-1980.Henneberry M and Stephens F (2018) Renal Hypoplasia and Dysplasia in Infants with Posterior Urethral ValvesJournal of Urology, VOL. 123, NO. 6, (912-915), Online publication date: 1-Jun-1980.J.W.D. (2018) Editorial CommentJournal of Urology, VOL. 123, NO. 6, (915-915), Online publication date: 1-Jun-1980.Stecker J, Read B and Poutasse E (2018) Pediatric Hypertension as a Delayed Sequela of Reflux-Induced Chronic PyelonephritisJournal of Urology, VOL. 118, NO. 4, (644-646), Online publication date: 1-Oct-1977.Willscher M, Bauer S, Zammuto P and Retik A (2018) Renal Growth and Urinary Infection Following Antireflux Surgery in Infants and ChildrenJournal of Urology, VOL. 115, NO. 6, (722-725), Online publication date: 1-Jun-1976. Volume 110Issue 3September 1973Page: 341-343 Advertisement Copyright & Permissions© 1973 by The American Urological Association Education and Research, Inc.MetricsAuthor Information John F. Stecker More articles by this author John G. Rose More articles by this author Jay Y. Gillenwater More articles by this author Expand All Advertisement Loading ...