Evaluating kidney damage from vesico-ureteral reflux in children

• Published in: Saudi journal of kidney diseases and transplantation 2009, Vol.20 (1), p.57-68
• Main Authors: Zaffanello, M, Franchini, M, Brugnara, M, Fanos, V
• Format: Article
• Language: English
• Subjects: Adolescent; Anti-Bacterial Agents - therapeutic use; Child; Child, Preschool; Children; Congenital kidney damage; Female; Humans; Infant; Infant, Newborn; Kidney - diagnostic imaging; Kidney - pathology; Kidney Diseases - diagnostic imaging; Kidney Diseases - etiology; Male; Medical research; Medicine, Experimental; Meta-analysis; Pediatric neurology; Primary vesico-ureteral reflux; Radiography; Radionuclide Imaging; Randomized Controlled Trials as Topic; Risk; Technetium Tc 99m Dimercaptosuccinic Acid; Urinary Tract Infections - diet therapy; Urinary Tract Infections - etiology; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - diagnostic imaging; Vesico-ureteral reflux in children; الأطفال; الأمراض; التشخيص; الجزر المثاني الحالبي; الجهاز العصبي; الضرر; الكلى; طب الأعصاب
• ISSN: 1319-2442; 2320-3838

To review the most relevant clinical studies that evaluate kidney damage in children with primary vesico-ureteral reflux (VUR), we reviewed and compared randomized controlled trials and clinical trials from scientific literature. In these studies, vesico-ureteral reflux was diagnosed by voiding cystourethrogram and kidney damage was assessed by either DMSA scan or urography. Relative risk with 95% confidence intervals was calculated using Review Manager Software (The Cochrane Collaboration, 2000). The overall relative risk of kidney damage shown by DMSA scan and urography was statistically higher in children with vesico-ureteral reflux of various degrees than in controls (3.7 times and 2.8 times, respectively). However, in high-grade VUR, the relative risk of congenital kidney damage was 5.6 times that of controls. We conclude that severe VUR is frequently associated with early kidney damage, perhaps with prenatal onset. Progression of kidney damage may depend on the severity of VUR and untreated urinary tract infections. Prevention of congenital kidney damage from severe VUR is possible when there is early intervention, even during fetal growth.