The association of adult kidney size with childhood vesicoureteral reflux

Stratifying Antenatal Hydronephrosis: Predicting High-Grade VUR Using Ultrasound and Scintigraphy

(1) Background: Antenatal hydronephrosis (AHN), detected in approximately one percent of prenatal ultrasounds, is caused by vesicoureteral reflux (VUR) in 15-21% of cases, a condition with significant risks such as urinary tract infections and renal scarring. Our study addresses the diagnostic challenges of VUR in AHN. Utilizing renal ultrasonography and scintigraphy, we developed a novel scoring system that accurately predicts high-grade VUR, optimizing diagnostic precision while minimizing the need for more invasive methods like voiding cystourethrogram (VCUG); (2) Methods: This retrospective study re-analyzed renal ultrasonography, scintigraphy, and VCUG images from infants admitted between 2003 and 2013, excluding cases with complex urinary anomalies; (3) Results: Our analysis included 124 patients (75% male), of whom 11% had high-grade VUR. The multivariate analysis identified visible ureter, reduced renal length, and decreased differential renal function (DRF) as primary predictors. Consequently, we established a three-tier risk score, classifying patients into low, intermediate, and high-risk groups for high-grade VUR, with corresponding prevalences of 2.3%, 22.2%, and 75.0%. The scoring system demonstrated 86% sensitivity and 79% specificity; (4) Conclusions: Our scoring system, focusing on objective parameters of the visible ureter, renal length, and DRF, effectively identifies high-grade VUR in AHN patients. This method enhances diagnostics in ANH by reducing reliance on VCUG and facilitating more tailored and less invasive patient care.

Variables affecting adolescent renal function in patients born with vesico-ureteric reflux

OBJECTIVE

To examine whether factors in a child's perinatal history influence renal function in adolescence, using a cross-sectional study, as during the past two decades researchers have tried to ascertain whether factors such as low birth weight might be related to a decline in kidney function in adolescence, although published data for children born with vesico-ureteric reflux (VUR) remain insufficient.

PATIENTS AND METHODS

Sixty-one children (20 boys and 41 girls), born between 1985 and 1989 in Greece and diagnosed with VUR, were assessed. A detailed personal and family history was taken and basic anthropometric variables were measured. Kidney function was calculated from serum creatinine levels, and the glomerular filtration rate (GFR), fractional excretion of sodium, albumin levels in urine, creatinine clearance, cystatin C level and the dimensions of each kidney were measured.

RESULTS

The results showed a positive relationship of birth weight (P = 0.01) with blood pressure in adolescence in children diagnosed with any degree of VUR. Renal function seemed to be intact whatever the cause of VUR, the volume of the kidneys in adolescence (P = 0.386 and 0.483, respectively, for the right and left kidney) and the values of GFR (P = 0.105), creatinine clearance (P = 0.213) and cystatin C (P = 0.055).

CONCLUSIONS

These results showed that although there is a positive association between blood pressure in adolescence and birth weight, in children born with VUR there was no deterioration in renal function. Kidneys seem to function normally regardless of the gestational age at birth.

Pregnancies in women with childhood vesicoureteral reflux

OBJECTIVE

The frequency of pregnancy complications together with renal scarring and voiding dysfunction-related risk factors were investigated in a cohort of women with a history of childhood vesicoureteral reflux (VUR).

DESIGN

A retrospective cross-sectional cohort study.

POPULATION

Eighty-seven primi- or multiparous middle-aged women diagnosed with primary non-obstructive VUR in childhood.

METHODS

Pregnancy outcome was assessed from case records and from patient interviews. Urine flow tests for voiding patterns, renal ultrasound for detecting scars, and blood samples for renal function were investigated. The median follow-up time was 38 years.

MAIN OUTCOME MEASURES

Prevalence of pregnancy complications in women with childhood VUR in relation to renal scars and voiding abnormalities.

RESULTS

Maternal complications were seen in 64% of the women and fetal complications in 13%. The women with renal scars (48/87) more often had hypertension (33%), proteinuria (40%) and urinary tract infections (42%) during pregnancy than women without scarring. The frequency of fetal complications was not increased by renal scarring or proteinuria during pregnancy. Urinary tract infections during pregnancy (33% of the women) and voiding abnormalities (18%) did not increase the frequency of fetal or maternal complications. The women with fetal complications were more predisposed to frequent urinary tract infections during adult life (55%) than were those without fetal complications (24%) (p = 0.04).

CONCLUSIONS

The maternal complication rates in women with childhood VUR were increased only by renal scarring. Frequent urinary tract infections during adulthood seemed to predict an elevated risk of fetal complications.