Vesicoureteral reflux (VUR) is a common kidney and urinary tract disorder in children, characterized by the backward flow of urine from the bladder to the ureter or pelvis. Children with VUR are at high risk for breakthrough urinary tract infections (BT-UTI) and may experience decreased kidney function. This can lead to a condition called reflux nephropathy, which can ultimately result in hypertension, albuminuria, chronic renal impairment, and even renal failure.
Reflux nephropathy often goes unnoticed in its early stages, with its pathology being marked by patchy interstitial scarring, tubular atrophy, and nephron atrophy. The exact mechanism behind VUR-induced regurgitant nephropathy remains unclear, but it is believed that repeated urinary tract infections and immune dysfunction play a role in its development.
To address the treatment of VUR, current strategies focus on reducing the occurrence of BT-UTIs and preventing kidney function impairment. However, recurrent BT-UTIs in children with VUR can lead to new renal scarring, which can have long-term consequences such as hypertension, albuminuria, renal impairment, and even renal failure.
In a recent retrospective cohort study published in Scientific Reports, researchers aimed to analyze the clinical data of children with VUR who received continuous antibiotic prophylaxis (CAP) treatment at a hospital in Xiamen from 2016 to 2019. The goal was to identify the risk factors for new kidney scarring in these children.
The study included 213 children diagnosed with VUR who received CAP intervention. The participants were enrolled based on their treatment-seeking for febrile urinary tract infections at the hospital’s Department of Nephrology. Only children who received regular CAP and had follow-up appointments were included in the study. Exclusion criteria were applied to ensure the focus on primary VUR cases and to exclude confounding factors.
The researchers analyzed various factors to determine their association with the development of new renal scarring. These factors included sex, age, pathogens at the initial diagnosis of urinary tract infection, grade of VUR, unilateral or bilateral VUR, presence or absence of renal scarring on a dimercaptosuccinic acid (DMSA) scan after the initial diagnosis of UTI, presence or absence of renal function impairment, and ultrasound abnormalities.
The results of the study indicated that certain factors were significantly associated with the occurrence of new renal scarring in children with VUR receiving CAP treatment. These risk factors included the presence of renal scarring on a DMSA scan after the initial diagnosis of UTI and the presence of renal function impairment. Sex, age, pathogens at the initial UTI diagnosis, VUR grade, bilateral or unilateral VUR, and ultrasound abnormalities did not show a significant association with new renal scarring.
The authors concluded that the presence of renal scarring after the initial diagnosis of UTI and renal function impairment are important predictors of new kidney scarring in children with VUR. These findings can aid in the identification of high-risk patients who may require closer monitoring and tailored treatment strategies to prevent the progression of renal scarring.
It is worth noting that this study focused specifically on children with VUR receiving CAP treatment, and the results may not be generalizable to all children with VUR or those receiving different treatment approaches. Further research is needed to confirm these findings and explore additional risk factors.
This study contributes to the understanding of risk factors for new renal scarring in children with VUR and highlights the importance of early detection and intervention. By identifying high-risk patients, healthcare providers can implement targeted strategies to minimize the long-term complications associated with VUR.
The findings of this study may have implications for the management and follow-up care of children with VUR, allowing for more personalized and effective treatment plans. Further research in this area is crucial to optimize outcomes and improve the quality of life for children with VUR.
In conclusion, this research sheds light on the risk factors for new renal scarring in children with VUR receiving CAP treatment. Early identification of these risk factors can enable healthcare providers to implement appropriate measures to prevent the progression of renal scarring and its associated complications. Further studies are necessary to validate these findings and explore additional factors that may influence the development of renal scarring in children with VUR.
