Renal Scarring and Osteopontin Gene C/T Polymorphism in Children With Primary Vesicoureteral Reflux.

We examined for osteopontin (OPN) gene C/T polymorphism in 78 patients (53 girls) with vesicoureteric reflux, with or without renal scarring. The T allele frequency was associated with a significantly increased risk (26.4 fold) of renal scarring.

Physical growth in children with reflux nephropathy with normal or mildly impaired renal function.

Ten children aged 11 months to 10 years (means 5.7 years) with reflux nephropathy, vesicoureteric reflux (VUR) and normal or mildly impaired renal function having GFR more than 50 ml/min/1.72 m2, were included in the study. The hematological and biochemical parameters were within normal limits. Height standard deviation score (HZ score) was reduced at entry and, decreased further during follow-up (-2.2 and -2.6 at 0 and 12 months, respectively). Weight for height index (WHI) improved significantly (p=0.0004) during follow-up. The basal and stimulated peak growth hormone levels of these patients were found to be elevated, 18.53 ± 11.36 μg/L and 34.20 ± 5.86 μg/L, respectively. The IGF-1 levels were low ranging from 45.00 to 84.40 ng/dl (mean ± SD 61.54 ± 10.21 ng/dl) compared to 51.80 to 247.50 ng/dl (mean ± SD111.20 ± 70.24 ng/dl) in age and sex matched controls, indicating partial insensitivity to growth hormone.

Multi-organ visualization in a DMSA renal scan of a nine-year-old male with reflux nephropathy

We present a case of a 9-year-old mole whose follow-up DMSA renal scan showed increased background activity with radio tracer uptake in the liver, cardiac pool, and blood vessels. The possible causes of this unusual finding were discussed. With the patient's medical history, his recent laboratory work-ups and after excluding all other possible causes, we come to a conclusion that the multi-organ visualization in our patient's DMSA renal scan was a result of his medical condition of chronic kidney disease secondary to reflux nephropathy.

The controversy and research progress of the vesicoureteral reflux / 国际儿科学杂志

Children with primary vesicoureteral reflux(VUR) are often complicated with urinary tract infection and voiding dysfunction.It often leads to kidney scarring,renal atrophy,hypertension,kidney dysfunction and a series performance of reflux nephropathy.In serious cases it can even progressed to end-stage renal disease.Now,with the accumulated experience of VUR treatment,the diagnosis strategy and the treatment remains certain amount of controversy.Whether the surgery or non-surgical treatment,the results are still not satisfactory,the pathogenesis of VUR is still unclear,the further study and exploration for the pathogenesis of VUR is required.

A Case of High Grade Vesicoureteral Reflux in Infancy Detected Early through the Sibling Screening Test

We report a case of severe(gradeV) unilateral vesicoureteral reflux(VUR) without any renal damage in a 6-month-old boy through the early sibling screening test for VUR, whose old brother had reflux nephropathy. The early detection of VUR aroused us to take special precautions to prevent urinary tract infection in this patient. We believe that this approach was helpful to reduce the risk of renal damage in this patient and are reporting the case with a brief review of related literatures. It is our firm suggestion that screening for vesicoureteral reflux should be carried out in every child who has siblings with reflux nephropathy.

Reflux Nephropathy Detected by Post-voiding Image on Scintigraphic Tc-99m MAG3 Scan

99mTc-MAG3 Scintigraphic Scan is sensitive at depicting focal parenchymal abnormalities and can be used for the measurement of overall renal function. We experienced a 12-year-old girl presenting with fever and flank pain. On the ultrasonogram and post-voiding delayed image of 99mTc-MAG3 scintigraphic scan, severe right cortical atrophy and hydronephrosis with vesicoureteral reflux were detected. We could demonstrate the reflux nephropathy by these two diagnostic work-up without conventional voiding cystourethrography.

Incidence of Vesicoureteral Reflux and Renal Scar in Asymptomatic Siblings of Patients with Primary Vesicoureteral Reflux

PURPOSE: Vesicoureteral reflux(VUR) is known to be the main cause of childhood hypertension and renal failure. Knowing its familial occurrence, we determined the incidence of VUR and renal scar in asymptomatic siblings of Korean patients with primary VUR. METHODS: A total of 50 siblings from 37 index patients were included. Voiding cystourethrography(VCUG) and renal scintigraphy using 99mTc-DMSA were performed in these siblings from June, 1994 to May, 2001. Index patients were classified into two groups according to the presence of VUR in their siblings, and the clinical factors of the index patients such as age, sex, grade of reflux and renal cortical defect were compared between the groups. RESULTS: Among the 50 siblings, VUR were found in 8(16%) and renal cortical defects were detected in 8(16%) siblings respectively. The incidence of renal cortical defects was 87.5%(7 out of 8) in the VUR(+) siblings. There was a case of VUR(-) cortical defect in one sibling, presumed as a scar from an old VUR. There was no relationship among age, sex, grade of reflux and renal cortical defect of the index patient to the presence of VUR in siblings. CONCLUSION: This study confirmed a significant incidence of VUR(16%) and renal cortical defects(16%) in the asymptomatic siblings of patients with primary VUR in Korea. It is resonable to recommend screening studies to the siblings of patients with VUR for the early detection and prevention of probable reflux nephropathy.

Incidence of Vesicoureteral Reflux and Renal Scar in Asymptomatic Siblings of Patients with Primary Vesicoureteral Reflux

PURPOSE: Vesicoureteral reflux(VUR) is known to be the main cause of childhood hypertension and renal failure. Knowing its familial occurrence, we determined the incidence of VUR and renal scar in asymptomatic siblings of Korean patients with primary VUR. METHODS: A total of 50 siblings from 37 index patients were included. Voiding cystourethrography(VCUG) and renal scintigraphy using 99mTc-DMSA were performed in these siblings from June, 1994 to May, 2001. Index patients were classified into two groups according to the presence of VUR in their siblings, and the clinical factors of the index patients such as age, sex, grade of reflux and renal cortical defect were compared between the groups. RESULTS: Among the 50 siblings, VUR were found in 8(16%) and renal cortical defects were detected in 8(16%) siblings respectively. The incidence of renal cortical defects was 87.5%(7 out of 8) in the VUR(+) siblings. There was a case of VUR(-) cortical defect in one sibling, presumed as a scar from an old VUR. There was no relationship among age, sex, grade of reflux and renal cortical defect of the index patient to the presence of VUR in siblings. CONCLUSION: This study confirmed a significant incidence of VUR(16%) and renal cortical defects(16%) in the asymptomatic siblings of patients with primary VUR in Korea. It is resonable to recommend screening studies to the siblings of patients with VUR for the early detection and prevention of probable reflux nephropathy.

Incidence of Vesicoureteral Reflux in Asymptomatic Siblings of Patients with Reflux

PURPOSE: Vesicoureteral reflux(VUR) is defined as a retrograde flow of urine from the bladder into the upper urinary tract. It has been shown to predispose patients to hypertension, renal scarring, and end-stage renal failure if not recognized and treated. The observation that VUR occurs in siblings of children with reflux at a significantly higher rate than the general pediatric population has been recognized for many years and VUR was detected in 26% to 51% of siblings of patients with VUR. The purpose of this study is to determine the incidence of VUR in asymptomatic siblings of children with VUR and to see if this form of screening would be practical. METHODS: We retrospectively reviewed the records of 28 patients with VUR and their siblings. The total number of asymptomatic siblings investigating VUR were 28 persons. All patients and siblings were evaluated for VUR by a voiding cystourethrography and all patients and siblings with VUR were performed 99mTc 2,3-dimercaptosuccinic acid renal scan. RESULTS: A total of 28 patients(14 boys, 14 girls) with VUR were studied; the mean patient age was 2.7 years(range 1 month to 8.4 years). The total number of asymptomatic siblings investigating VUR were 28 persons(17 boys, 11 girls) and the mean age was 3.3 years(range 2 months to 7.4 years). Renal scar was detected in 20 of 28(71.4%) patients with VUR. VUR was noted in three of 28(10.7%) siblings and renal scar was detected in one of three siblings with VUR. CONCLUSIONS: In this study, the predictive value of a positive family history alone in identifying VUR was 10.7%. This incidence suggests more investigation of asymptomatic siblings and continued study of this group of patients at risk is needed for clarifying the family screening of patients with VUR.

A Family Screening of Patients with Vesicoureteral Reflux

PURPOSE : Vesicoureteral reflux is the most commonly inherited disease detected in children with urinary tract infection. The incidence of vesicoureteral reflux among siblings of children with known vesicoureteral reflux is 8% to 45% according to different authors. Family screening of a patient with vesicoureteral reflux is important in order to prevent reflux nephropathy. The purpose of this study is to determine the incidence of vesicoureteral reflux in asymptomatic family of children with vesicoureteral reflux and the factors which influence the family history. METHODS : The study group consisted of 27 families of patients with vesicoureteral reflux. The total number in the group were 79 persons. BUN, Cr, urineanalysis, voidingcystourethrography(VCUG) and 99mTc -dimercaptosuccinic acid(DMSA) renal scan were performed on the siblings. As for the parents the same tests were performed except the VCUG. RESULTS : The abnormality was detected in 7 of 27 families(25.9%). Vesicoureteral reflux was detected in 5 of 20 siblings and renal scar was detected in 3 of 32 parents. In children with vesicoureteral reflux, renal scar was detected in 24 of 32 children. Between the group with the abnormality in its family(Group A) and the group without the abnormality in its family(Group B), There was no difference of creatinine clearance between two groups. More renal scars were detected in group A according to the DMSA(A:100%, B:75%, t-test p<0.05). There was no difference of grade of VCUG between two groups. There was no difference between one site and both sites in two groups. In the case of the siblings with vesicoureteral reflux, there was high incidence of renal scar in a patient with vesicoureteral reflux according to the DMSA. CONCLUSION : It is important to screen vesicoureteral reflux and renal scar in case of urinary tract infection to prevent reflux nephropathy. This study implies that it is necessary to screen the family of a patient with vesicoureteral reflux especially with renal scar.

Factors Associated with Renal Failure in Children with Primary Vesicoureteral Reflux

PURPOSE: The pathophysiologic mechanisms and risk factors of renal functional deterioration are still controversial. We analyzed the factors associated with renal failure in children with primary vesicoureteral reflux. METHODS: The medical records of 166 children who were diagnosed with primary vesicoureteral reflux from Jan. 1985 to Dec. 1996 in the Department of Pediatrics, Seoul National University Children's Hospital were reviewed retrospectively. The patients were divided into two groups according to renal function: patients with renal failure(RF group) and patients with normal renal function(NRF group). RESULTS: Eighteen(11%) were classified as RF group, and 16(89%) of them were male. Sixteen (89%) of RF group revealed decreased renal function at the time of diagnosis. There was no past history of documented urinary tract infection in 16(89%) of RF group. Patients of RF group had a higher grade of reflux as compared with those of NRF group. Proteinuria and hypertension were found in 16(89%) and 6(33%) of RF group, respectively, while no NRF patients had proteinuria or hypertension. Renal functional deterioration had progressed to end-stage renal disease in 6(33%) of RF group during a mean follow-up of 4.4+/-2.7(range 0.5-12) years. CONCLUSION: Reflux nephropathy and renal scar in children can be prevented, in some cases, by early diagnosis of vesicoureteral reflux and prophylaxis of urinary tract infection. Regular check up for proteinuria and hypertension is essential for early detection of renal dysfunction. However, in other patients, especially in male, renal dysfunction can develop independently on urinary tract infection.

A Clinical Observation on Reflux Nephropathy : Outcome of Renal Function in Vesicoureteral Reflux Patients with Proteinuria / 대한비뇨기과학회지

We have followed up 13 cases of primary bilateral vesicoureteral reflux with proteinuria, of which 11 cases treated with antireflux surgery and 2 cases conservatively, on patients who were admitted to the Dept. of Urology, Pusan National University Hospital from Jan. 1974 to Dec. 1986 for one to 13 years of period. The results are as follows : 1. Most of cases in primary bilateral vesicoureteral reflux with proteinuria were associated with pyelonephritis. Also, in about two third of cases, the patients demonstrated high degree of bilateral vesicoureteral reflux with deteriorated renal function. 2. Of cases with deteriorated renal function in preoperative period, the operation had no beneficial effect on renal function. Also, in cases with conservative treatment, the renal function was further deteriorated and progressed to renal failure. Of cases associated with proteinuria and renal scar in preoperative period, all of them showed no improvement in renal scar with either conservative treatment or antireflux surgery. 3. Urinary tract infection was ameliorated with antireflux surgery in cases of vesicoureteral reflux with proteinuria and, furthermore, proteinuria was improved in a lot of cases. However, with conservative treatment, urinary tract infection and proteinuria showed no improvement.

Reflux Nephropathy in Children / 대한비뇨기과학회지

Although an association of the childhood urinary tract infection, vesicoureteral reflux and renal scarring has been recognized for more than 20 years, it is unclear whether renal scar can be caused by vesicoureteral reflux alone, infection alone, or only when both factors are operative. This clinical review with 52 kidneys of vesicoureteral reflux has the aim of evaluation of the role of vesicoureteral reflux and urinary tract infection in the development of the renal scar. In this study, author got the following results: 1. The renal scar was noticed in overall 63.5% among the reflux cases ranging from 25% in Grade I to 100% in Grade V and number and severity proportionated to the grade of the reflux. 2. Urinary tract infection was more commonly present with high grades of the reflux and almost all cases over III were combined with the urinary tract infection. 3. It seemed to be increased potential for development of renal scar in those patients with associated vesicoureteral reflux and urinary tract infection, but author couldn't find out which one influenced more deeply in development of the renal scar. In conclusion, vesicoureteral reflux only may be sufficient to cause the renal scarring, which seems to proportionate to the degree of the reflux, and the combined urinary tract infection which is commonly present also plays an important role in causing the renal scarring.