Renal functional changes in schoolgirls with covert asymptomatic bacteriuria

Focal and segmental glomerulosclerosis in children with reflux nephropathy

A histological review of 86 pediatric nephrectomy specimens from patients with vesicoureteric reflux (with or without apparent obstruction at the vesicoureteric junction) investigated the relationship between the presence and extent of focal and segmental glomerulosclerosis (FSGS) and coexisting renal hypoplasia and postnatally acquired cortical damage. FSGS was found in 18 patients, 9 of whom were less than 5 years old. There was no significant association between the presence (or grade) or absence of FSGS and age at nephrectomy, gender, presence or absence of obstruction, and severity of hypoplasia and/or postnatally acquired cortical loss. FSGS was absent from 18 hypoplastic kidneys without vesicoureteric reflux (although of relatively young age), 40 normally developed kidneys age-matched with the index population, and 72 nephrectomy specimens without vesicoureteric reflux (except in 2 known cases of focal segmental glomerulonephritis). Within the index population FSGS was significantly (P < .01) associated with hypertension, and hypertension was significantly associated with proteinuria (P < .001) but not with an abnormal contralateral kidney. There was no significant association between FSGS, proteinuria, and an abnormal contralateral kidney. Our results were unexpected when interpreted within a pathogenesis for FSGS of glomerular "hyperfiltration." They may, at least in the pediatric age group, indicate a possible role for other mechanisms in the development of FSGS.

Vesicoureteral reflux

Vesicoureteral reflux, the regurgitation of urine from the bladder into the ureters, varies in severity. Controversy persists in relation to the cause, diagnosis, significance, and treatment of this condition. The practitioner's role in early referral and treatment of urinary tract infection is important to prevent renal damage. Patient and family support and education about reflux, diagnosis, and follow-up is crucial. Early diagnosis and optimal management will preserve maximal renal function, and patient education will foster compliance and quality care.

Reflux nephropathy

This article reviews current concepts of reflux nephropathy, including the pathophysiology, diagnosis, relationship to infection, role in causing end-stage renal disease, and appropriate treatment and management. The condition is defined from a epidemiologic point of view herein, and attention also is given to possible progressions this condition can take.

Urinary tract infections in infants and children. Guidelines for averting permanent damage

Urinary tract infection (UTI) is common in childhood and, early in life, is often associated with vesicoureteral reflux or other urinary tract anomalies. Since the combination of reflux and infection can cause renal scarring and impaired renal function, identification of children at risk and provision of close follow-up are important. Diagnosis in the first year of life relies on a high index of suspicion on the part of the clinician, as signs and symptoms are nonspecific. Reliable cultures are the cornerstone of accurate diagnosis and will be the basis for selection of acute and long-term management. Vigilant follow-up of all children with UTI can prevent ultimate morbidity.