title: Impact of early screening for reflux in siblings on the detection of renal damage.
abstract: OBJECTIVE
  To assess the impact of screening siblings after detecting significant vesico-ureteric reflux (VUR) and renal scarring, as such screening might identify patients with VUR before urinary tract infections develop, but might also detect clinically insignificant VUR.
  
  
  METHODS
  We used a previously reported screening protocol to assess the clinical characteristics of patients, including the incidence of renal scarring, and their siblings, and compared the results. In all, 123 children were screened and 44 (36%) had VUR on voiding cystography. The median (range) age at screening was 9 (1-90) months.
  
  
  RESULTS
  The grades of VUR detected were < III in 61% and > or = III in 39%; VUR was bilateral in 48%. In all, 37 siblings with VUR were assessed by ultrasonography; 70% were normal, including 12 (32%) children with VUR of grade > or = III. When used, renal scintigraphy was normal in 74% of siblings, vs 18% of index patients. However, when screened after 2 years old, siblings had twice the risk of already having renal damage on renal scintigraphy (P = 0.04).
  
  
  CONCLUSIONS
  Early screening (< or = 2 years) appears to be more protective for avoiding renal damage than screening older patients. Thus we propose early screening in asymptomatic siblings to detect VUR before it becomes clinically significant.
authors.affiliation: Urology Division, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Houle
authors.forename: Alaa
authors.initials: A
authors.lastname: Cheikhelard
authors.forename: Diego
authors.initials: D
authors.lastname: Barrieras
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Rivest
authors.forename: Valérie
authors.initials: V
authors.lastname: Gaudreault
mesh_terms: D002675:Child, Preschool; D002921:Cicatrix; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000379:methods*; D011866:Radioisotope Renography / Q000379:methods; D019275:Radiopharmaceuticals; D012307:Risk Factors; D035781:Siblings; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014463:Ultrasonography; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000517:prevention & control*
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid