Unilateral vesicoureteric reflux: Low prevalence of contralateral renal damage.
OBJECTIVE
We assessed the risk for the occurrence of renal damage in children with vesicoureteric reflux (VUR).


METHODS
We reviewed the records of 187 consecutive children, aged 3.8 +/- (SD) 2.8 years, with unilateral primary VUR diagnosed after urinary tract infection (UTI). Dimercaptosuccinic acid renal scintigraphy was performed 4 to 6 months after the last UTI. Three patterns of renal damage were identified: global reduction (GR) of renal radionuclide uptake (20% to 40% of relative uptake), focal defects (FD) in uptake, and shrunken (relative uptake <20%) kidney (SK). We assumed that in these subjects FD indicated postpyelonephritic damage and that GR indicated congenital renal damage.


RESULTS
Scintigraphic renal damage of any type was present in 36.9% of the refluxing and in 3.2% of the nonrefluxing kidneys (odds ratio [OR], 17.6; 95% CI, 7.4 to 41.9). FD were present in 15.5% and 2.7% (OR, 6.7; CI, 2.5-17.6), GR in 19% and 0.5% (OR, 44.3; CI, 6.1 to 327.2), and SK in 6.9% and 0%, respectively. Patients with severe VUR showed a higher probability of renal damage than those with nonsevere VUR.


CONCLUSIONS
In children with UTI and VUR, the refluxing kidney is most at risk of both congenital and acquired renal damage, and this risk increases with severity of reflux.
Polito
C
C
Department of Pediatrics, Nuclear Medicine, Second University of Naples, Via S. Andrea celle Dame, 4, I-80138 Naples, Italy.
Rambaldi
P F
PF
Mansi
L
L
Di Toro
R
R
La Manna
A
A
D002675:Child, Preschool; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D015995:Prevalence; D011877:Radionuclide Imaging; D014552:Urinary Tract Infections / Q000150:complications; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000000981:diagnostic imaging