title: Vesicoureteric reflux deterioration in monozygotic twins.
abstract: Primary vesicoureteric reflux (VUR) is the most common inherited structural urinary tract disorder, conforming closely to autosomal dominant transmission. A pair of monozygotic siblings is described exhibiting a remarkably parallel clinical course. VUR grade II was diagnosed in girl A during urinary tract infection at the age of 2 yr; screening of her asymptomatic sister (girl B) revealed the same. Renal cortical scintigraphy unveiled unilateral hypo-dysplasia in both the twins. Despite trimethoprime-sulfamethoxazole prophylaxis, infection recurred in girl A after 7 months, while girl B had a first episode 2 months later that prompted regimen switch to nitrofurantoin. Follow-up at the age of 4 depicted bilateral reflux deterioration; an urodynamics study that followed revealed functional bladder instability in both girls and the oral antispasmodic oxybutynin was initiated with good results. Evaluation for reflux should be prompt in infants with urinary infection. Patient siblings display a higher relative reflux risk, being highest in identical twins. Heredity issues, the impact of age and dysfunctional voiding in the clinical course, and the contribution of nuclear medicine in VUR management are discussed.
authors: Nuclear Medicine Department, Pediatric Nephrology Clinic, University General Hospital of Ioannina, Ioannina, Greece. spytsi@gmail.com
authors: Spyridon
authors: S
authors: Tsiouris
authors: Chrissa
authors: C
authors: Sioka
authors: Anna
authors: A
authors: Marinarou
authors: Jihad
authors: J
authors: Al-Bokharhli
authors: Irene
authors: I
authors: Sionti
authors: Andreas
authors: A
authors: Fotopoulos
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008333:Mandelic Acids / Q000627:therapeutic use; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D011866:Radioisotope Renography; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014430:Twins, Monozygotic; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000188:drug therapy
chemical_list: D008333:Mandelic Acids; D018727:Muscarinic Antagonists; D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; C005419:oxybutynin