Abstract
Risk factors for renal scarring in children with lower urinary tract dysfunction (LUTD) were evaluated. The medical records of 120 patients were assessed concerning gender, presence of vesicoureteric reflux (VUR), bladder capacity, detrusor overactivity, residual urine, febrile urinary tract infection (UTI), bacteriuria, constipation, detrusor sphincter incoordination (DSI), high detrusor pressure at maximal cystometric capacity (PMCC), low compliance, and thickness and trabeculation of the bladder wall. Renal scarring was diagnosed by 99mtechnetium-dimercaptosuccinic acid renal scan (DMSA). Renal scarring was detected in 38 patients (31%). VUR, UTI, decreased bladder capacity, urinary residue, and trabeculated and thick bladder wall were associated with scarring at univariate analysis. Multivariate analysis showed VUR (P < 0.0001) as the independent risk factor for renal scarring. Thickness of the bladder wall was a marginal risk factor (P= 0.07). Although UTI was not a risk factor, it was associated with VUR (P= 0.03). In our analysis, VUR was the main risk factor; however, renal scarring was probably due to multifactorial causes, as VUR was associated with UTI.
Similar content being viewed by others
References
Ottolini M, Shaer CM, Rushton H, Majd M, Gonzales E, Patel K (1995) Relationship of asymptomatic bacteriuria and renal scarring in children with neuropathic bladders who are practicing clean intermittent catheterization. J Pediatr 127:368–372
Capitanucci M, Iacobelli B, Silveri M, Mosiello G, De Gennaro M (1996) Long-term urological follow-up of occult spinal dysraphism in children. Eur J Pediatr Surg 6:25–26
Silveri M, Capitanicci M, Capozza N, Mosiello G, Silvano A, De Gennaro M (1997) Occult spinal dysraphism: neurogenic voiding dysfunction and long-term urologic follow-up. Pediatr Surg Int 12:148–150
Mostwin J (2002) Pathophysiology: the varieties of bladder overactivity. Urology 60:22–26
Norgaard JP, van Gool JD, Hjalmas K, Djurhuus JC, Hellstrom AL (1998) Standardization and definitions in lower urinary tract dysfunction in children. International Children’s Continence Society. Br J Urol 81:1–16
Koff SA, Jayanthi VR (2002) Section B: non-neurogenic lower urinary tract dysfunction. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds) Campbell’s urology, 8th edn. Saunders, Philadelphia, pp 2261–2283
Mc Guire EJ, Woodside JR, Borden TA, Weiss RM (1981) Prognostic value of urodynamic testing myelodysplastic patients. J Urol 126:205–209
Vega-P JM, Pascual LA (2001) High-pressure bladder: an underlying factor mediating renal damage in the absence of reflux? BJU Int 87:581–584
Bauer SB (2002) Section A: neuropathic dysfunction of the lower urinary tract. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds) Campbell’s urology, 8th edn. Saunders, Philadelphia pp 2231–2261
Allen TD (2003) Forty years experience with voiding dysfunction. BJU Int 92:15–22
Teichman JM, Scherz HC, Kim KD, Cho DH, Packer MG, Kaplan GW (1994) An alternative approach to myelodysplasia management: aggressive observation and prompt intervention. J Urol 152:807–811
Yang CC, Mayo ME (1997) Morbidity of dysfunctional voiding syndrome. Urology 49:445–448
Benador A, Benador N, Slosman DO, Nussle D, Mermillod B, Girardin E (1994) Cortical scintigraphy in the evaluation of renal parenchymal changes in children with pyelonephritis. J Pediatr 124:17–20
Ditchfield MR, Grimwood K, Cook DJ, Powell HR, Sloane R, Gulati S, de Campo JF (2004) Persistent renal cortical scintigram defects in children 2 years after urinary tract infection. Pediatr Radiol 34:465–471
Goldraich NP, Goldraich IH (1995) Update on dimercaptosuccinic acid renal scanning in children with urinary tract infection. Pediatr Nephrol 9:221–226
Smellie JM, Ridgen SP, Prescod NP (1995) Urinary tract infection: a comparison of four methods of investigation. Arch Dis Child 72:247–250
Filgueiras MF, Lima EM, Sanchez TM, Goulart EM, Menezes AC, Pires CR (2003) Bladder dysfunction: diagnosis with dynamic US. Radiology 227:340–344
Hansson S, Jodal U (2004) Urinary tract infection. In: Avner ED, Harmon W, Niaudet P (eds) Pediatric nephrology. Lippincott Williams & Wilkins, Philadelphia, pp 1007–1025
Neveus T, von Gotard A, Hoebeke P, Hjalmas K, Bauer S, Bower W, Jorgensen TM, Ritting S, Walle JV, Yeung CK, Djurhuus JC (2006) The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol 176:314–324
Jequier S, Rousseau O (1987) Sonographic measurements of the normal bladder wall in children. AJR Am J Roentgenol 149:563–566
Jakobsson B, Jacobson SH, Hjalmas K (1999) Vesico-ureteric reflux and other risk factors for renal damage: identification of high- and low-risk children. Acta Paediatr 88(Suppl 431):31–39
Orellana P, Baquedano P, Rangarajan V, Zhao JH, Eng ND, Fettich J, Chaiwatanarat T, Sonmezoglu K, Kumar D, Park YH, Samuel Am, Sixt R, Bhatnagar V, Padhy AK (2004) Relationship between acute pyelonephritis, renal scarring, and vesicoureteral reflux. Results of a coordinated research project. Pediatr Nephrol 19:1122–1126
Gleeson FV, Gordon I (1991) Imaging in urinary tract infection. Arch Dis Child 66:1282–1283
Linshaw MA (1996) Asymptomatic bacteriuria and vesicoureteral reflux in children. Kidney Int 50:312–329
Schlager, TA, Dilks S, Trudell J (1995) Bacteriuria in children with neurogenic bladder treated with intermittent catheterization: natural history. J Pediatr 126:490–496
Naseer S, Steinhardt GF (1997) New renal scars in children with urinary tract infections, vesicoureteral reflux and voiding dysfunction: a prospective evaluation. J Urol 158:566–568
Snodgrass W (1991) Relationship of voiding dysfunction to urinary tract infection and vesicoureteral reflux in children. Urology 38:341–344
Allen TD (1992) Commentary: voiding dysfunction and reflux. J Urol 148:1706–1707
Winberg J (2001) Does low birthweight facilitate postinfectious focal renal scarring? Acta Paediatr 90:835–836
Winberg J (1992) Progressive renal damage from infection with or without reflux. J Urol 148:1733–1734
Shortliffe LM (2002) Urinary tract infections in infants and children. In: Walsh PC, Retik AB, Vaughan ED, Wein AJ (eds) Campbell’s urology, 8th edn. Saunders, Philadelphia, pp 1846–1884
Holland N, Jackson E, Kazee M, Conrad GR, Ryo UY (1990) Relation of urinary tract infection and vesicoureteral reflux to scars: follow up in 38 patients. J Pediatr 116:S65–S71
Silva JM, Santos Diniz JS, Marino VS, Lima EM, Cardoso LS, Vasconcelos MA, Oliveira EA (2006) Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 21:981–988
Homayoon K, Chen JJ, Cummings JM, Steinhardt GF (2005) Voiding dysfunction: outcome in infants with congenital vesicoureteral reflux. Urology 66:1091–1094
Sillen U (1999) Bladder dysfunction in children with vesico-ureteric reflux. Acta Paediatr 88(Suppl 431):40–47
Miranda JE, Pareja RR, Barredo JMG, Caffaratti, Bertran PA, Mas AG (1997) Reflujo vesicoureteral asociado a inestabilidad del detrusor. An Esp Pediatr 47:245–250
Koff SA, Wagner TT, Jayianthi VR (1998) The relationship among dysfunctional elimination syndromes, primary vesicoureteral reflux and urinary tract infections in children. J Urol 160:1019–1022
Gallo D (1970) Urinary retention due to fecal impaction in children. Pediatrics 45:292–294
O’Regan S, Schick E, Hamburdger B, Yasbeck S (1986) Constipation associated with vesicoureteral reflux. Urology 28:394–396
Edelstein RA, Bauer S, Kelly ND, Darbey MM, Peters CA, Atala A, Mandell J, Colodny AH, Retik A (1995) The long-term urological response of neonates with myelodysplasia treated proactively with intermittent catheterization and anticholinergic therapy. J Urol 154:1500–1504
Geraniotis E, Koff SA, Enrile B (1998) The prophylactic use of clean intermittent catheterization in the treatment of infants and young children with myelomeningocele and neurogenic bladder dysfunction. J Urol 139:85–86
Shapiro E, Becich MJ, Perlman E, Lepor H (1991) Bladder wall abnormalities in myelodysplastic bladders: a computer assisted morphometric analysis. J Urol 145:1024–1029
Deveaud CM, Macarak EJ, Kucich U, Ewalt DH, Abrams WR, Howard PS (1998) Molecular analysis of collagens in bladder fibrosis. J Urol 160:1518–1527
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Leonardo, C.R., Filgueiras, M.F.T., Vasconcelos, M.M. et al. Risk factors for renal scarring in children and adolescents with lower urinary tract dysfunction. Pediatr Nephrol 22, 1891–1896 (2007). https://doi.org/10.1007/s00467-007-0564-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0564-5