Risk Of Vesicoureteral Reflux Research Articles

Anatomical location and number of injection sites of intravesical OnabotulinumtoxinA for females with refractory idiopathic overactive bladder: Ascoping review.

The negative impact on quality of life and the economic-related burden to the patient and the health care system associated with idiopathic overactive bladder (iOAB) is well-documented. Intradetrusor OnabotulinumtoxinA (BTN/A) injections are a well-used treatment modality for the management of overactive detrusor refractory to medical management, with well-documented efficacy and safety profiles. There is currently no best practice guideline for the administration of BTN/A for this procedure and historically the trigone of the bladder has been excluded from the injection paradigm given the risk of vesicoureteral reflux (VUR). A scoping review methodology was employed to assess available literature to evaluate current techniques used. There is emerging literature that the inclusion of the trigone may increase the efficacy of the procedure, while maintaining a similar adverse effect profile. Similar results could also be obtained by decreasing the number of injection sites. A scoping review was completed with systematic methodology using the Preferred Systematic Reviews and Meta Analyses extension for Scoping Review checklist. The search strategy looked to evaluate BTN/A and number of injection sites and the inclusion of the trigone in female patients with iOAB. Studies with male or neurogenic bladder only were excluded. Mixed studies were included. A specialist research librarian was engaged, with supervision from a functional urologist using a combination of MeSH and natural language terms. Two investigators independently reviewed the titles and abstracts. Twelve articles were included and were published between 2005 and 2021. There was no evidence of VUR in any of the results. All but one study reported similar if not improved efficacy of trigone-inclusion. Lower number of injection sites had similar efficacy profiles to higher numbers of intradetrusor injections. Further high-quality randomized control trials of trigone inclusion and reduction of injection sites are required. It is hoped that with further exploration of intraoperative methods for BTN/A injections, the development of universally accepted guidelines may optimize management and experiences for patients with iOAB.

Allograft Vesicoureteral Reflux after Kidney Transplantation.

Allograft vesicoureteral reflux (VUR) is a leading urological complication of kidney transplantation. Despite the relatively high incidence, there is a lack of consensus regarding VUR risk factors, impact on renal function, and management. Dialysis vintage and atrophic bladder have been recognized as the most relevant recipient-related determinants of post-transplant VUR, whilst possible relationships with sex, age, and ureteral implantation technique remain debated. Clinical manifestations vary from an asymptomatic condition to persistent or recurrent urinary tract infections (UTIs). Voiding cystourethrography is widely accepted as the gold standard diagnostic modality, and the reflux is generally graded following the International Reflux Study Committee Scale. Long-term transplant outcomes of recipients with asymptomatic grade I-III VUR are yet to be clarified. On the contrary, available data suggest that symptomatic grade IV-V VUR may lead to progressive allograft dysfunction and premature transplant loss. Therapeutic options include watchful waiting, prolonged antibiotic suppression, sub-mucosal endoscopic injection of dextranomer/hyaluronic acid copolymer at the site of the ureteral anastomosis, and surgery. Indication for specific treatments depends on recipient’s characteristics (age, frailty, compliance with antibiotics), renal function (serum creatinine concentration < 2.5 vs. ≥ 2.5 mg/dL), severity of UTIs, and VUR grading (grade I-III vs. IV-V). Current evidence supporting surgical referral over more conservative strategies is weak. Therefore, a tailored approach should be preferred. Properly designed studies, with adequate sample size and follow-up, are warranted to clarify those unresolved issues.

Risk factors of vesicoureteral reflux and urinary tract infections in children with imperforate anus: A population-based case-control study in Taiwan.

Imperforate anus (IA) is associated with several urological anomalies, including vesicoureteral reflux (VUR), a major contributor to high morbidity in patients with anorectal malformations. This retrospective study was performed to elucidate the risk factors of vesicoureteral reflux (VUR) and UTI in children with IA.We used the National Health Insurance Research Database (NHIRD) to estimate the frequency of congenital anomalies of the kidney and urinary tract (CAKUT) in children with IA. We also investigated the frequencies of VUR, UTI, and CAKUT in children with IA along with the risk factors of VUR.We enrolled 613 children between 2000 and 2008 (367 males and 246 females; 489 low-position IA and 124 high-position IA). High-position IA was associated with a significantly increased risk of VUR compared with low-position IA (OR: 2.68, 95% CI: 1.61, 4.45). In addition, children with IA along with CAKUT, hydronephrosis, or UTI had a higher risk of VUR (OR: 8.57, 95% CI: 3.75, 19.6; OR: 7.65, 95% CI: 4.48, 13.1; and OR: 31.8, 95% CI: 11.5, 88.3, respectively). UTI, as well as chromosomal anomalies, were more frequent in children with high-position IA.Patients with a high-position IA had a greater risk of VUR, particularly those with CAKUT, hydronephrosis, or UTI. Such patients must periodically undergo urinalysis to screen for UTI and early voiding cystourethrogram to rule out VUR and prevent consequent renal damage. Chromosomal analysis is suggested to rule out Down syndrome.

Association of Genetic Polymorphisms in GSTP1, GSTM1, and GSTT1 Genes with Vesicoureteral Reflux Susceptibility in the Children of Southeast Iran.

Background:Vesicoureteral reflux (VUR) disease is the most common type of urinary tract anomalies in children. Genetic risk factors may be associated with the etiology of VUR. The role of the Glutathione S-transferases (GSTs) as multifunctional enzymes is cellular oxidative stress handling. This is the first study aimed at evaluating the relative risk of GSTP1, GSTM1, and GSTT1 polymorphisms in VUR susceptibility in children and provides new important insights into the genetics of affected children.Methods:The study was done in 2013 in Sistan and Baluchestan University, eastern Iran. Genotyping of three GSTP1, GSTM1, and GSTT1 genes were determined using the multiplex polymerase chain reaction assay in 216 reactions for 72 VUR children and 312 reactions for 104 healthy controls.Results:The presence of GSTT1 deletion was associated with high risk of VUR in children, whereas GSTP1 and GSTM1 genotypes did not show the same effect. Furthermore, the combination of GSTT1/GSTM1 and GSTT1/ GSTP1 genotypes showed a significant influence on lower risk of VUR in children.Conclusion:Deletion of GSTT1 functional gene is a genetic risk factor causing VUR in children. Interestingly, the combination of GSTM1 and GSTP1 null genotypes with GSTT1 has shown a protective role against risk of GSTT1 deletion.

Clinical Characteristics of Pediatric Pyelonephritis Without Pyuria or Bacteriuria.

The gold standard for the diagnosis of acute pyelonephritis (APN) in children is the finding of both pyuria (P) and bacteriuria (B); however, some APN patients have neither of these findings [APN(P(-);B(-))]. In this study, we investigated APN patients who visited our hospital over 14 years to identify specific clinical characteristics of APN(P(-);B(-)). A total of 171 APN patients were included in the study, and of these 29 were APN(P(-);B(-)). Of the APN(P(-);B(-)) patients, 25.9% had vesicoureteral reflux (VUR), the same percentage as the APN(P(+);B(+)) patients, and 69.0% of APN(P(-);B(-)) patients had already taken antibiotics before diagnosis. APN(P(-);B(-)) patients were older and had a longer duration between onset of fever and diagnosis than the patients with pyuria and/or bacteriuria. In addition, they showed higher C-reactive protein levels. APN(P(-);B(-)) patients had high levels of urinary α-1 microglobulin and urinary β-2 microglobulin. APN is difficult to diagnose in febrile patients who display neither pyuria nor bacteriuria, but as these patients have the same risk for VUR as APN patients with pyuria and bacteriuria, a detailed history establishing the clinical course as well as urinary chemistry investigations, may assist in diagnosis.

Value of screening for vesicoureteral reflux in infants with antenatal hydronephrosis in king abdulaziz medical city-Riyadh

Background: Antenatal hydronephrosis (AHN) is diagnosed in 0.5%–1% of pregnancies. Hydronephrosis has many causes, but vesicoureteral reflux (VUR) remains an important cause, as it could lead to serious damage to the kidneys. Screening for VUR by voiding cystourethrogram (VCUG) is done in infants with congenital hydronephrosis to detect VUR that could lead to repeated urinary tract infections (UTIs). Objectives: The aim of the study was to investigate the value of VCUG as a screening tool for VUR in infants with various grades of hydronephrosis. Materials and Methods: This is a retrospective chart review for all infants with antenatal hydronephrosis between January 2010 and December 2015 at King Abdulaziz Medical City-Riyadh. Comparisons were made between hydronephrosis grades and VUR. Differences, therefore, were assessed for statistical significance using Chi-square test as appropriate. Analysis was performed using SPSS version 22. Results: During the study periods, 203 infants (75% of the study population) underwent VCUG. VUR was diagnosed in 21% of all infants who had VCUG. VUR was significantly higher in infants with high grade compared to low-grade hydronephrosis (30% versus 14.40%, P = 0.005). On the other hand, no significant difference found between high-grade hydronephrosis and low-grade hydronephrosis in the severity of VUR (P = 0.169). Meanwhile, high-grade hydronephrosis was significantly more associated with UTI 27.20% (25/92) than low-grade hydronephrosis 14.70% (26/177). Conclusion: Infants with antenatal hydronephrosis (HN) suffer greater morbidity as reflected by the increased incidence of VUR and UTI at follow-up. For high-grade HN, our recommendation clearly goes with the current practice for doing VCUG to all high-grade patients. On the other hand, the risk of VUR and UTI, although higher in infants with high-grade HN is still substantial in infants with low-grade HN. However, it is still controversial to do VCUG for them. Hence, we recommend further big researches about low-grade HN and VCUG to come up with clear conclusion for this HN group.

Did our current initial treatment practice change after EAU/ESPU vesicoureteral reflux risk grouping?

Background/PurposeThe “European Association of Urology (EAU) Guidelines on Vesicoureteral Reflux (VUR) in Children (September 2012)” established risk classification by analyzing and defining risk factors for each patient. In this study we aimed to investigate how our initial treatment procedures were affected by EAU/ESPU guideline vesicoureteral reflux risk grouping and to compare the early clinical results of treatments performed before and after the risk classification in our patients with VUR. Materials and methods334 renal units with regular clinical follow-up who were treated owing to VUR (vesicoureteral reflux) between years 2009 and 2017 were retrospectively reviewed. Preoperative clinical parameters such as grade and laterality of reflux, presence of renal scar, initial and follow-up treatments, findings of medical treatment and surgical procedures were analyzed. The initial medical and surgical methods were compared by categorizing patients according to risk groups before and after 2013. ResultsMean age and follow-up duration were 71.4(6–216) months and 47(4–141) months, respectively. Among the preoperative parameters, only high EAU risk group (p = 0.01) and treating lower urinary tract symptoms (p < 0.001) were determining the postoperative success rates significantly, while age, sex, and presence of renal scar at DMSA were not affecting the success of treatment significantly. While no significant difference in medical and surgical treatment rates is observed after risk grouping system in low risk group, the percentages of patients who are treated with surgical methods initially were significantly decreased in moderate and high risk groups (p = 0.002 and p = 0.012, respectively). We determined that VUR risk grouping did not change clinical success significantly in all risk groups. ConclusionsDespite the fact that EAU/ESPU VUR risk classification changed our current practice in terms of initial treatment method, this different approach did not seem to affect early clinical success positively. There is still an absolute need for studies with larger sample size and long-term follow-up to reach more reliable results. Type of studyTherapeutic. Level of evidenceLevel 4.

Diagnostic Value of Technetium-99m-Dimercaptosuccinic Acid Scintigraphy in Prediction of Vesicoureteral Reflux in Children with First-time Febrile Urinary Tract Infection

Background: Imaging modalities such as voiding cystourethrography (VCUG), direct radionuclide cystography (DRNC), and renal cortical scintigraphy (RCS) with technetium-99m dimercaptosuccinic acid (Tc-99mDMSA), are helpful in detecting possible abnormalities of urinary tract such as vesicoureteral reflux (VUR). However, there are confounding data regarding the preference of these modalities. In the present study, we aimed to assess the role of Tc-99mDMSA scan in prediction of possible VUR and the subsequent need for VCUG or DRNC. Materials and Methods: Three hundred fifty seven children under 14 years old with first-time febrile urinary tract infection (UTI) who were admitted between April 2004 and February 2017 were enrolled. Data regarding to VCUG or DRNC in order to evaluate the presence of possible VUR were recorded. Finally, accuracy of Tc-99mDMSA scans in prediction of VUR were assessed. Results: Analyses showed a sensitivity and specificity of 95.65% and 14.72%, respectively for Tc-99mDMSA scan in detection of VUR. Patients with mild renal involvement in Tc-99mDMSA scans had a 3.5-fold greater risk of having VUR than those with a normal scans (odds ratio=3.5; 95% confidence interval [CI]: 1.4-8.58; p=0.007). In addition, the risk of VUR is up to 7.0-fold greater in children with moderate renal involvement (odds ratio=7.0; 95% CI: 2.6-13.2; p<0.0001) and up to 9.2-fold greater in children with severe renal involvement (odds ratio=9.2; 95% CI: 3.2-17.3; p=0.007) in the Tc-99mDMSA scans compared to those with a normal scans. Conclusion: According to the results, Tc-99mDMSA scan can be used as a screening test in prediction of VUR in infants and children with first- time febrile UTI.

Analysis of the IL-10, IL-12, and TNF-α Gene Polymorphisms in Patients With Vesicoureteral Reflux Among the Southeast Iranian Population.

BackgroundVesicoureteral reflux (VUR) is a common childhood disorder that is characterized by the abnormal movement of urine from the bladder into the ureters or kidneys.ObjectivesThe aim of this study was to determine whether the genetic polymorphisms of the IL-10, IL-12, and TNF-α genes are involved in the development of VUR.Patients and MethodsThe tetra amplification mutation refractory system-polymerase chain reaction (Tetra-ARMS PCR) was applied to analyze the four polymorphic sites of the IL-10AG-1082, IL-10CA597, IL-12CA1188, and TNF308GA genes in 124 VUR children and 110 healthy controls.ResultsA significant, highly increased risk of VUR disease was found for the CA, AA, and combined genotypes of IL-10CA597 (OR = 5.2, 95% CL: 1.80 - 18.25; P = 0.0006, OR = 9.1, 95% CL: 1.11 - 122.75; P = 0.02, OR = 5.3, 95% CL: 1.82 - 18.61; P = 0.00052, respectively); the AG, GG, and AG + GG genotypes of IL-10AG-1082 (OR = 12.8, 95% CL; 2.9 - 113.9; P = 0.00003, OR = 12.62, 95% CL: 2.93 - 114.53; P = 0.00003, respectively); and the AA genotype of IL-12 (AA, OR = 0.19, 95% CL: 0.5 - 0.55; P = 0.0006). The frequency of the C allele in both IL-10CA and IL-12CA was greater in patients with VUR than in the healthy controls. No association was found between TNF308GA and the risk of VUR.ConclusionsThe results demonstrated significant associations between the IL-10 (AG-1089, IL-10CA) and IL-12 (AA) gene polymorphisms and a highly increased risk of VUR.

Angiotensin Converting Enzyme Gene Insertion/Deletion Polymorphism and Vesicoureteral Reflux in Children: A Meta-Analysis of 14 Case-Control Studies.

Vesicoureteral reflux (VUR) is a common and serious urinary disease in children. It usually causes renal scar, urinary tract infection, and chronic renal failure. Previous studies showed the angiotensin converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism might be associated with VUR; however, the conclusions were inconsistent. Therefore we used the meta-analytic approach to clarify the effect of ACE I/D polymorphism on VUR risk.We systematically searched the PubMed, CNKI, and EMBASE databases to identify all the potentially related studies published up to February 4, 2015. Two reviewers independently selected studies and extracted data. The strength of the association was assessed using odd ratio (OR) with its 95% confidence interval (CI) based on fixed or random effects model. The STATA 12.0 software was used for data analysis.A total of 14 case-control studies involving 1197 VUR patients and 1320 healthy controls met the eligibility criteria. Results of meta-analysis showed significant association between ACE I/D polymorphism and VUR risk (D vs. I: OR = 1.28, 95% CI = 1.06-1.54, P = 0.01; DD vs. II: OR = 1.44, 95% CI = 1.12-1.85, P = 0.01; DD vs. DI + II: OR = 1.49, 95% CI = 1.23-1.79, P < 0.01; DD + DI vs. II: OR = 1.20, 95% CI = 0.84-1.72, P = 0.31). Subgroup analyses revealed varied results. In Turkish people, results of all the genetic models other than DI vs. II showed statistical significance; in Caucasians, DD vs. DI + II showed statistical significance; and in Asians, DI versus II showed statistical significance.Our meta-analysis indicated that the ACE I/D polymorphism might be associated with increased risk of VUR in children. However, due to the limitations, we suggest conducting additional studies with larger sample size and adjustment for various risk factors, in the future for further clarification.

Incidence of Urinary Tract Infection Among Siblings of Children With Vesicoureteral Reflux

BackgroundSiblings of children with vesicoureteral reflux (VUR) are at elevated risk of VUR. Screening siblings may identify VUR before a clinical illness such as a urinary tract infection (UTI), but the benefit of screening has not been demonstrated. We sought to determine the incidence of UTI among siblings, and we hypothesized that the sibling UTI rate is similar between screened and unscreened siblings. MethodsWe performed a retrospective cohort analysis using insurance claims data (January 1, 2000, to December 31, 2009). Within each family, we identified the index VUR patient and siblings; we included siblings who were enrolled in the insurance plan from birth for at least 1 year. We identified siblings who were screened for VUR and/or had UTI. We investigated the association of screening and UTI, controlling for patient characteristics and clustering within families. ResultsAmong 617 siblings (associated with 497 index patients), 317 (51%) were girls. Median insurance enrollment time was 53.0 months, with 424 enrolled ≥3 years. Among those with 1 or 3 years of enrollment, the proportions of siblings who experienced UTI was 8.4% (52 of 617) and 10.4% (44 of 424), respectively. Median age at initial UTI was 32.7 months. A total of 223 siblings (36.0%) underwent sibling screening. There was no significant difference in UTI between screened and unscreened siblings (odds ratio 1.57, 95% confidence interval 0.87–2.85; P = .14). In multivariate analysis, screening was not associated with sibling UTI incidence (odds ratio 1.33, 95% confidence interval 0.68–2.60; P = .40). ConclusionsAlthough UTI is relatively common among siblings of VUR patients, there was no statistically significant difference in UTI incidence between screened and unscreened siblings.

PS-369 Timing Of Voiding Cystourethrogram In The Investigation Of Urinary Tract Infections In Children: A Systematic Review And Meta-analysis

Background Voiding cystourethrogram (VCUG) is considered the gold standard for detecting vesicoureteral reflux (VUR). Optimal timing of VCUG after urinary tract infections (UTI) is controversial. Single studies have compared rates of VUR according to timing of VCUG, but included a limited number of patients and failed to reach definitive conclusions. Objective We conducted a systematic review and meta-analysis of studies that compared rates of VUR when VCUG was performed early versus late in the investigation of UTI. Methods We searched MEDLINE, EMBASE, CINHAL and CENTRAL. We included studies that compared the rates of VUR between early versus late-performed VCUG in children diagnosed with UTI. We used the threshold of early vs. late reported by the authors: most commonly at 7 days, but no later than 14 days. Studies that focused on patients with previously diagnosed VUR or other urogenital pathology were excluded. Pairs of reviewers independently screened potentially eligible articles, extracted data and assessed quality of the evidence according to the GRADE framework. Results Of the 1526 studies reviewed, 7 studies with 1623 patients were included (2 prospective and 5 retrospective cohort studies). Meta-analysis showed no increased risk of VUR in early versus late performed VCUG (Odds ratio 0.99, 95% CI 0.77 to 1.27, corresponding to a risk difference of 0.00, 95% CI -0.05 to 0.04, I 2 = 0%). The overall quality of the evidence was moderate. Conclusions In children diagnosed with UTI, there is no significant difference in rates of VUR when VCUG is performed early rather than later.

Bladder Volume Change and Post-Transplant Vesicoureteral Reflux (VUR) in Pediatric Recipients With Atrophic Bladder After Kidney Transplantation.

Background Children with CKD have high prevalence of atrophic bladder due to disused situation and inadequate bladder-cycling after long-term dialysis and congenital urinary tract anormaly. Small capacity bladder have potential risks of ureterocystoneostomy. We retrospective reviewed our surgical outcome of ureterocystoneostomy and bladder volume change at 4 months after kidney transplantation in pediatric recipients with atrophic bladder. Methods Between 2000 and 2012, 153 pediatric renal transplant recipients were performed kidney transplantation with evaluation of bladder size using voiding cystography before and 4 months after transplantation. Patients with neurogenic bladder were excluded. Definition of atrophic bladder volume is less than 50% of estimated bladder capacity(30×(age+1)) under 10 years old and less than 150ml over 10 years old. Result Seventy-two (47.1%) pediatric recipients showed atrophic bladder (42 males and 30 females). Average age of transplants is 7.2±5.3 years old. Average height is 107.2±22.8cm and weight is 19.2±10.9kg. Mean bladder volume is 46.0±35.1ml at pre-transplant and 164±80.4ml at 4 months after transplant. The bladder capacity of pre-transplant atrophic bladder significantly increased approximately 3 times at 4 months after transplantation regardless of pre-transplant age, bladder volume and body weight. There is a significant difference of the incidence of post-transplant vesicoureteral reflux(VUR) in the graft between the atrophic baladder and the normal group(14.1%: 1.2%). Procedures of ureterocystoneostomy in the atrophic bladder group were intravesical(P-L) method (n=37), extravesical(L-G) method(n=34) and uretero-ureterostomy(n=1). There is no significant difference of prevalence of VUR in the graft kidney between P-L and L-G method(13.5%(n=5); 14.7%(n=5)). However, there is a significant difference of the incidence of VUR among pre-transplant bladder capacity(0-50ml:19.6%, 50-100ml:4.8%,100-150ml:0%). Conclusion Pediatric kidney recipients had high prevalence of atrophic bladder, and the improvement of bladder volume is excellent without special procedure of ureterocystoneostomy and pre-transplant management in pediatric recipients. However there is potential high risk of VUR in recipients with atrophic bladder.

Renal Cortical Abnormalities in Siblings of Index Patients With Vesicoureteral Reflux

Screening siblings of index patients with vesicoureteral reflux (VUR) has been proposed to identify children who are at risk for renal damage. However, screening siblings for VUR remains controversial. We investigated the prevalence of VUR and renal cortical abnormalities in the sibling population in a large cohort of families with VUR. Between 1998 and 2012, parents of index patients with grade III to V VUR were asked permission to screen siblings <6 years of age for VUR. Siblings were divided into 2 groups: siblings with a documented history of a previous urinary tract infection (UTI) and siblings who were screened for VUR and never had a UTI. A logistic regression model was used to determine independent risk factors associated with renal cortical abnormalities such as history of presentation, age, gender, and grade of VUR. There were 318 siblings in 275 families in the study. VUR was found after screening in 190 (60%) siblings and after a UTI in 128 (40%). Multivariate analysis revealed that siblings who had a previous UTI (odds ratio: 3.38), siblings with high grade reflux (odds ratio: 3.62), and siblings over 1 year of age (odds ratio: 2.84) were the most significant independent risk factors associated with renal cortical abnormalities. There is increased risk of renal cortical abnormalities in siblings with a previous UTI, siblings with high-grade VUR, and siblings over age 1 year. This information may help to counsel parents about the risk of VUR and reflux nephropathy in familial VUR.

Current Medical Diagnosis and Management of Vesicoureteral Reflux in Children

Vesico-ureteral reflux (VUR) is presented in approximately %1 of children and is associated with an increased risk of pyelonephritis and renal scarring. Despite its prevalence and morbidity, many aspects of VUR diagnosis and treatment are controversial. We objectively assessed the published data; the data base for many current diagnoses and treatment patterns of VUR is limited. Recent studies have focused on developed determination of VUR-related renal morbidity, improved stratification tools that children would benefit most from which VUR treatment option, and improved reporting of the long-term outcomes of VUR treatments in children who are at risk for VUR. In this review, the advances in the diagnosis and treatment of VUR will be accompanied by the current guidelines.

Effect of pro-inflammatory cytokine (IFN-γ +874, IL-18–137 G/C,–607 C/A) genes in relation to risk of vesico-ureteral reflux

Aim: The aim this work is to estimate whether genetic polymorphisms of +874 of IFN-γ and −137 G/C,−607 C/A of IL-18 genes are implicated in the development of VUR, because a vast literature indicates that genetic variations play a significant role in the pathogenesis of VUR. Materials and methods: The PCR single specific primer (SSP) and amplification refractory mutation system (ARMS) were applied for analyzing the polymorphic sites of −137 G/C,−607 C/A of IL-18 and +874 of IFN-γ genes in 110 healthy controls and 124 VUR children. Results: A significant relationship was found between AT and combined AT + TT genotypes of IFN-γ and highly increased risk of VUR (OR = 4.2, 95% CI, 2.00–9.24; p < 0.0001: OR = 4.00, 95% CI, 1.90–8.70, p < 0.0001, respectively). On the other hand, the genotype frequency of IL18-137 G/C indicated a significant assessment of the decrease risk of VUR for GC and GC + CC genotypes (OR = 0.53, 95% CI, 0.3–0.9; p = 0.02: OR = 0.53, 95% CI, 0.3–0.92 p = 0.01, respectively). No significant association was found between −607 C/A polymorphism of IL-18 and UVR. Conclusion: To the author's best knowledge, this is the first data regarding polymorphism of IFN-γ (+874) cytokine genes that highly increased the risk of VUR. To confirm the presented data, further studies should be done in different populations with a larger sample size.

Impact of Pretransplant Dialysis Duration, Bladder Capacity and Length of Submucosal Tunnel of Ureteroneocystostomy on the Prevalence of Vesicoureteral Reflux to the Graft

Introduction and Objective: Vesicoureteral reflux (VUR) is a risk factor in the transplanted kidney. Renal allograft recipients have various pre-transplant urinary bladder conditions. Patients with anuria due to long-term dialysis show a distinct decrease in the bladder capacity and compliance. It can be difficult to make a submucosal tunnel of adequate length to prevent VUR with a small bladder capacity. Long-term dialysis and the pre-transplant small bladder capacity were associated with VUR (Inoue T, et al. Transplantation 2011). This study investigated the impact of the pre-transplant dialysis duration, bladder capacity, and the length of submucosal tunnel of ureteroneocystostomy on the prevalence of VUR to the graft. Methods: We have employed anti-reflux ureteroneocystostomy using an anterior extravesical technique without a stent. A submucosal tunnel was created at approximately but less than 3 cm between 1998 and 2006 (Group 1, n=102) and more than 3 cm since 2007 (Group 2, n=62). Voiding cystography was performed in 164 adult renal transplant recipients immediately before and one year after transplantation to measure the bladder capacity and confirm the existence of VUR. Additionally, urodynamic study was preformed at pre-transplantation in 21 patients and 1-year post-transplantation in 48 patients to evaluate the bladder function in Group 2. Result: The median age (range) was 46 (19-71) years old. The median pre-transplant dialysis duration was 60 (0-426) months. The median pre- and post-transplant bladder capacity was 165 (15-600) and 376 (117-1,000) ml, respectively. The median pre- and post-transplant compliance was 42.6 (0.41-369) and 87.5 (3.44-495) ml/mmH2O, respectively. The bladder capacity and compliance expanded more than 2-fold from pre-transplantation to 1-year post-transplantation. Thirty-six (22%) patients had VUR to the graft. A significant difference was found between Groups 1 and 2 in the dialysis duration (72 vs. 40 months, respectively, p=0.00036), pre-transplant bladder capacity (134.5 vs. 215.7ml, respectively, p=0.00019), and the prevalence of VUR (n=30, 29.4% vs. n=6, 9.7%, respectively, p=0.002). In addition, the prevalence of VUR in patients with over a 100-ml pre-transplant bladder capacity was 53.3% in Group 1 and 16.7% in Group 2. This indicates that it is important to make a submucosal tunnel over 3 cm long to prevent VUR to the graft. Conclusions: Long-term dialysis, pre-transplant small bladder capacity, insufficient length of submucosal tunnel of ureteroneocystostomy may increase the risk of VUR.

IL-19 and IL-20 genes polymorphisms and haplotype analysis in a vesicoureteral reflux population

Vesicoureteral reflux (VUR) is a common childhood problem, causing renal wounds and escalating the risk of renal deficiency and hypertension. A vast literature exists suggesting that genetic variations play a significant role in the pathogenesis of VUR. The aim of the present study was to estimate whether genetic polymorphisms of IL-19 (GC rs2243158, AT rs2243158) and IL-20 (AG rs2981573, TG rs2981572) genes are involved in the development of VUR. The tetra amplification mutation refractory system-polymerase chain reaction (Tetra-ARMS PCR) was applied for analyzing four polymorphic sites of IL-19 (GC rs2243158, AT rs2243158) and IL-20 (AG rs2981573, TG rs2981572) genes in 110 healthy controls and 124 VUR children. A significant association was found between the combined genotypes of IL19GC+CC and IL20TG+GG and increased risk of VUR (OR = 1.90, 95% CL, 1.06-3.41; OR=1.87, 95% CL, 1.06-3.29, respectively). The frequency of allele G in both sites of IL-20 (IL20AG rs2981573 and IL20TG, rs2981572) showed a statistically significant difference (p = 0.01) between cases and controls in comparison with the wild type. The combined haplotype analysis of IL-19 and IL-20 polymorphic sites revealed that HT2, HT3 and HT5 haplotypes marginally increased the risk of VUR, but not statistically significantly. Gene-gene interaction data of IL-19 (GC rs2243158, AT rs2243158) and IL-20 (AG rs2981573, TG rs2981572) in various genotype patterns highlighted the fact that most of the genotype combinations increased the risk of disease insignificantly. This is the first evidence regarding IL-19 and IL-20 cytokine genes polymorphism and risk of VUR, suggesting the need for further study with large sample size and in different populations to confirm the presented data.

2129 IS SMALL BLADDER CAPACITY DUE TO LONG-TERM DIALYSIS ASSOCIATED WITH THE INCIDENCE OF VESICO-URETERAL REFLUX AFTER TRANSPLANTATION?

INTRODUCTION AND OBJECTIVES: Urinary bladder capacity is reduced in patients undergoing long-term dialysis, which may increase the risk of vesicoureteral reflux (VUR) to a transplanted kidney. This study investigated the correlations between dialysis duration, preand post-transplant bladder capacity, and prevalence of VUR to the graft. METHODS: Voiding cystography was performed in 101 adult renal transplant recipients without neurogenic disorders immediately before and 1 year after transplantation to evaluate bladder capacity and VUR. Non-stented extravesical anti-reflux ureteroneocystostomy was performed in all patients. RESULTS: The median (range) dialysis duration and pretransplant bladder capacity were 32 (1-426) months and 120 (15-450) ml, and 21 patients (20.8%) underwent dialysis for more than 120 months and 30 patients (29.7%) had a pre-transplant bladder capacity of less than 80 ml. Dialysis duration was correlated with pretransplant bladder capacity (R2 0466, p 0.001). Bladder capacity expanded more than 6-fold from preto post-transplantation, and all recipients had a bladder capacity greater than 150 ml at 1 year post-transplantation. Thirty patients had VUR to the graft. Dialysis duration longer than 120 months (p 0.048) and pre-transplant bladder capacity of less than 130 ml (p 0.024) were associated with VUR. VUR was associated with lower graft function. CONCLUSIONS: Although bladder capacity deceased due to long-term dialysis, it exceeded 150 ml at 1 year post-transplantation. The small capacity bladder resulting from long-term dialysis can be used in kidney transplantation, but this condition may represent an increased risk of VUR which can be cause of lower graft function. Source of Funding: None

Association of ACE I/D gene polymorphism with vesicoureteral reflux susceptibility in children: a meta-analysis

Many studies have been conducted to investigate the association between angiotensin-converting enzyme (ACE) insertion (I)/deletion (D) gene polymorphism and vesicoureteral reflux (VUR) susceptibility. However, the results from those studies are still conflicting. We performed a meta-analysis of studies relating the ACE I/D gene polymorphism to the risk of VUR. We searched the databases of PubMed, Embase, Cochrane Library and CBM-disc (China Biological Medicine Database) as of 1 March 2011, and recruited the eligible investigations for this meta-analysis. Ten investigations were identified for the analysis of association between ACE I/D gene polymorphism and VUR risk: six in Caucasians, three in East-Asians and one in a Turkish population. All the investigations were performed in children. There was no marked association between ACE I/D gene polymorphism and VUR susceptibility/renal scar for overall populations, Caucasians and East-Asians. In the Turkish population, D allele and DD genotype were associated with the VUR susceptibility/renal scar. Furthermore, ACE I/D gene polymorphism was not associated with VUR progression. D allele and DD genotype are risk factors for the VUR susceptibility/renal scar in Turkish children. However, more case-control association investigations on larger, stratified populations are required in the future.