Vesicoureteral Reflux In Siblings Research Articles

VESICOURETERAL REFLUX INCIDENCE IN SIBLINGS OF CHILDREN WITH REFLUX: IS SCREENING REQUIRED?

Aim: The purpose of this study was to evaluate prospectively the age-related incidence and severity of primary vesicoureteral reflux (VUR) in siblings of children with reflux and to conclude whether screening of this group is required or not. Methods: A total of 71 siblings (32 boys, 39 girls) of reflux patients, aged less than 15 years (mean age, 8.4 years) were included in the study. Examination methods including urinalysis, urine culture, renal ultrasonography, and voiding cystourethrography were performed in all of the siblings. Additionally, 99m technetium (Tc)-dimercaptosuccinic acid (DMSA) renal cortical scintigraphy was performed in siblings with VUR. Results: Primary VUR was found in 10 (14%) of the siblings, and the incidence for girls and boys were 41.7% and 9.3%, respectively. The reflux incidence in siblings aged less than 6 years was 40%, whereas in siblings older than 6 years it was found 60%. DMSA scintigraphy was performed on all the siblings with VUR, of whom 5 had normal and 5 had abnormal findings. Conclusion: The incidence of primary VUR in siblings of affected children was found higher compared to the siblings of children without the disease, supporting the necessity to screen this population.

Familial Vesicoureteral Reflux: Influence of Sex on Prevalence and Expression

Familial clustering of vesicoureteral reflux implies that genetic factors have an important role in the pathogenesis of vesicoureteral reflux. We investigated the impact of sex on familial vesicoureteral reflux. Between 1998 and 2003 we identified 159 white families with at least 2 children (range 2 to 5) with vesicoureteral reflux confirmed by a voiding cystourethrogram. Families were divided into 3 groups, including group 1 with only boys affected (29 or 18%), group 2 with only girls affected (57 or 36%) and group 3 with boys and girls affected (73 or 46%). Clinical characteristics, reflux grade and associated renal anomalies in these 3 groups were compared using the Mann-Whitney U and chi-square tests for statistical analysis. Sisters of index female patients were at significantly higher risk for vesicoureteral reflux than brothers (p <0.01). Boys in group 1 had a significantly higher grade of vesicoureteral reflux than boys in group 3, and girls in groups 3 and 2 (p = 0.018, <0.001 and <0.0001, respectively). Severe renal scarring was present in 7% of boys in group 1, 6.6% of boys in group 3, 1.3% of girls in group 3 and 1.9% of girls in group 2. Duplex kidneys were present in 15.3% of boys in group 1 but only in 2.3% of boys in group 3 (p <0.01), 5.7% of girls in group 3 and 5.8% of girls in group 2. Age at diagnosis was not significantly different among boys in groups 1 and 3, and girls in group 2 (median 0.9, 0.6 and 1.9 years, respectively). The risk and severity of vesicoureteral reflux in siblings depends on the sex of the affected child. Brothers of index male patients have higher grade of reflux and higher rate of associated duplex systems. This has implications for genetic counseling and for modeling the inheritance of vesicoureteral reflux.

Should Siblings of Patients with VUR be Screened?

Urology| February 01 2003 Should Siblings of Patients with VUR be Screened? AAP Grand Rounds (2003) 9 (2): 14. https://doi.org/10.1542/gr.9-2-14 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Should Siblings of Patients with VUR be Screened?. AAP Grand Rounds February 2003; 9 (2): 14. https://doi.org/10.1542/gr.9-2-14 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: relationship - sibling, gastroesophageal reflux disease, renal scarring Source: Hollowell JG. Screening siblings for vesicoureteral reflux. J Urol. 2002;168:2138–2141. While numerous studies have documented that siblings of children with vesicoureteral reflux (VUR) have an increased incidence of ureteral reflux, these studies have differed not only in the incidence of reflux reported but also in the risk of renal scarring associated with reflux. The author from Eastern Pennsylvania reviewed the literature using MEDLINE (1985-present) and identified 11 studies that reported on the use of cystograms to screen siblings of index patients with VUR. A total of 1,768 siblings were screened. The mean incidence of VUR was 32% (570 of 1,768). The incidence of VUR varied by age with an incidence as high as 45% among siblings less than 2 years and decreasing to 10% for those over age 6 years. Two-thirds of the siblings were found to have nondilating reflux grades I to II, while one-third had grades III and IV. The presence of renal scarring in the index patient and the age of the index patient were unrelated to the results of the siblings’ screening. Of 570 siblings identified, 482 (85%) had upper tract evaluations. Renal scarring was identified in 14% (10 out of 70) of siblings shown to have VUR when a dimercaptosuccinic acid (DMSA) scan was obtained and in 2.8% (4 out of 140) when a renal ultrasound was employed. The other 360 patients had their upper tract evaluations by 1 or more methods and the results were not stratified by evaluation type. In 2.8% of siblings renal scarring was severe enough to produce a diminution in function. Most siblings found to have renal scarring had no known history of urinary tract infection. The resolution rate for reflux among siblings was equal to or greater than among the index cases that presented with infection. The author speculates that much of the renal damage was due to dysplasia rather than infectious scarring. Since scarring was present in 25% of patients with VUR and infection prior to their second birthday, the author recommends screening siblings less than 2 years of age, but does not make a recommendation for older siblings. This report underscores the increased incidence of vesicoureteral reflux in siblings of patients diagnosed with VUR. Younger patients had a higher incidence of reflux, were more likely to have high-grade reflux, and were more prone to renal damage than were older patients. Renal ultrasonography cannot reliably exclude VUR but may reveal hydronephrosis in patients with high-grade reflux and detect some clinically significant renal scars. While identification of patients with dilated collecting systems and high-grade reflux (grade IV and V) can be helpful, new renal scars develop in 5 to 21% of patients who are being treated with prophylactic antibiotics.1 Also, nondilating reflux is present in up to 50% of patients with renal scarring. For screening siblings, a nuclear cystogram is preferable to a fluoroscopic voiding cystourethrogram because radionuclide cystography is more sensitive and exposes the patient to less radiation than does a... You do not currently have access to this content.

Natural history of vesicoureteral reflux in siblings: L.P. Connolly, S.T. Treves, D. Zurakowski, et al. J Urol 156:1805–1807, (November), 1996

Natural history of vesicoureteral reflux in siblings: L.P. Connolly, S.T. Treves, D. Zurakowski, et al. J Urol 156:1805–1807, (November), 1996

Silent renal damage in symptom-free siblings of children with vesicoureteral reflux: Assessment with technetium Tc 99m dimercaptosuccinic acid scintigraphy

Sixteen symptom-free siblings of children with vesicoureteral reflux were found to have the condition and underwent renal scintigraphy with technetium 99m dimercaptosuccinic acid. Of these 16 children, 6 had scintigraphic evidence of renal damage. Screening for vesicoureteral reflux in siblings of children known to have the condition should therefore be carried out early in life; when reflux is present, an immediate assessment of the renal parenchyma should be made.

Vesicoureteral Reflux in Asymptomatic Siblings of Patients With Known Reflux: Radionuclide Cystography

The familial nature of vesicoureteral reflux among siblings of patients with vesicoureteral reflux has been reported to be from 8% to 32%. These included both symptomatic and asymptomatic siblings. The incidence of vesicoureteral reflux in asymptomatic siblings, however, has not been studied extensively. Sixty asymptomatic siblings of patients known to have vesicoureteral reflux were studied with radionuclide voiding cystography. Their ages ranged from 2 months to 15 years (mean, 4.2 years). Vesicoureteral reflux was detected in 27 of 60 (45%) of the siblings. Vesicoureteral reflux was unilateral in 15 and bilateral in 12 of the siblings. Radionuclide cystography is more sensitive than radiographic cystography and results in a very low radiation dose to the patient. The gonadal dose with radionuclide cystography is only 1.0 to 2.0 mrads. Because of these features, radionuclide cystography is a nearly ideal technique for the diagnosis of vesicoureteral reflux in siblings of patients with known vesicoureteral reflux. All siblings (symptomatic or asymptomatic) of patients with known vesicoureteral reflux should have a screening radionuclide cystography.

Vesicoureteral Reflux

Vesicoureteral reflux in siblings or different generations has not been emphasized. In nine families, each with two members having unilateral or bilateral reflux, at least one member from each family has required surgical correction. Family surveys demonstrated other congenital and acquired urinary tract abnormalities. Failure of conservative management plus cystoscopic evidence of a defective ureteral orifice support a familial or hereditary basis for vesicoureteral reflux.

Vesicoureteral reflux. An inherited lesion

Vesicoureteral reflux in siblings or different generations has not been emphasized. In nine families, each with two members having unilateral or bilateral reflux, at least one member from each family has required surgical correction. Family surveys demonstrated other congenital and acquired urinary tract abnormalities. Failure of conservative management plus cystoscopic evidence of a defective ureteral orifice support a familial or hereditary basis for vesicoureteral reflux.