Relationship between Vesicoureteral Reflux and Glomerular Filtration Rate in Children
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40(5):845-850,2020
845
Relationship between Vesicoureteral Reflux and Glomerular Filtration Rate in Children* Wei ZHANG1, Hui-ming YI1, Xiao-le ZHANG2, Yong-hong YI2, Jian-hua ZHOU2, Li-ru QIU2# 1 Department of Ultrasound, 2Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China Huazhong University of Science and Technology 2020
Summary: Vesicoureteral reflux (VUR) is one of the most common urinary tract anomalies in children and causes renal damage and studies focusing on the effect of VUR on renal function are rare. We recruited 35 primary VUR patients with recurrent urinary tract infection (UTI) and 10 nonVUR patients with recurrent UTI. Contrast-enhanced voiding urosonography (ceVUS) was performed for VUR grading, and renal dynamic imaging was used for evaluating glomerular filtration rate (GFR, mL/min). Standardized GFR (sGFR), namely GFR/BSA (mL·min–1·m–2), was calculated based on the body surface area (BSA). Total sGFR (tsGFR, mL·min–1·m–2) was obtained from the sum of sGFR on the left and right sides of all the children. The risk of renal regurgitation was equal in the unilateral reflux group. The sGFR of children with grade Ⅳ (45.74±18.05 mL·min–1·m–2) and grade Ⅴ (49.67±23.63 mL·min–1·m–2) reflux was significantly lower than that in children with grade Ⅲ (77.69 ±22.21 mL·min–1·m–2). The renal function compensation of contralateral non-reflux kidney increased in unilateral reflux group, which was higher than that in the control group and level Ⅱ, Ⅳ and Ⅴ of reflux group respectively. In VUR group of the same grade, sGFR decreased with the age at diagnosis. In unilateral grade Ⅴ reflux group, the tsGFR was lower than that in the unilateral grade Ⅲ reflux group (133.51±48.21 vs. 186.87±53.49 mL·min–1·m–2). The patients with VUR of unilateral grade Ⅱ were significantly older than those with VUR of unilateral grades Ⅲ and Ⅳ. This study indicates that severe VUR is significantly associated with decreased renal function. Therefore, VUR should be diagnosed early and managed individually. Key words: vesicoureteral reflux; renal dynamic imaging; glomerular filtration rate; renal damage; children
Vesicoureteral reflux (VUR) is one of the most common urinary tract anomalies in children and it is the retrograde ascension of urine from the bladder to the upper urinary tract during urine storage and/ or voiding, which affects 1%–2% of all children, and up to one-third of whom will experience urinary tract infection (UTI)[1]. Acute pyelonephritis associated with VUR can lead to renal scarring. Over time, substantial scarring may engender long-term complications such as hypertension, proteinuria, renal failure which is collectively known as reflux nephropathy (RN). RN has been reported as one of the most common causes of pediatric chronic kidney disease (CKD)[2, 3]. In many clinical studies, the relationship between UTI, VUR and renal scarring has been established[4]. The higher the VUR grade, the more renal scarring can be found[5]. But inv
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