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Pediatric Nephrology

, Volume 24, Issue 2, pp 223–226 | Cite as

Vesicoureteral reflux, a benign condition

  • Mika Venhola
  • Matti Uhari
Editorial Commentary

Abstract

The combination of urinary tract infection (UTI) and vesicoureteral reflux (VUR) is commonly thought to predispose the child to pyelonephritis, renal scarring and, later in life, to hypertension or end-stage renal disease (ESRD). This paradigm has led to the active search, follow-up and treatment of VUR, and also prevention of recurrent UTI in children. The causality of VUR and ESRD is controversial, however. According to recent meta-analyses it is uncertain whether we can prevent renal scarring or ESRD by treating VUR. Studies on VUR are abundant, but the findings and conclusions are confounding. Because of the lack of evidence of the role of VUR, reasonable doubt has recently been presented on the rationale of imaging all children with UTI and treating the children with VUR. The overall importance of VUR is confounded because of the natural tendency of VUR to resolve spontaneously, its dynamic nature, and its different grades in children. The historical studies showing that VUR is much more common, even among healthy children, than usually claimed, have been forgotten. Since it seems that we are referring too many healthy children to unpleasant and possibly unnecessary imaging tests for VUR, we are uncertain when and what kind of VUR—if any—we should treat, and whether our present rationale of addressing VUR truly makes any difference to renal scarring or ESRD in children, we should critically revisit the subject of VUR.

Keywords

Vesicoureteral reflux Urinary tract infection Kidney Child 

References

  1. 1.
    Smellie J, Edwards D, Hunter N, Normand IC, Prescod N (1975) Vesico-ureteric reflux and renal scarring. Kidney Int 4:S65–S72Google Scholar
  2. 2.
    Hodson CJ (1979) Reflux nephropathy. Masson Publishing USA, New YorkGoogle Scholar
  3. 3.
    Kollermann MW, Ludwig H (1967) On vesico-ureteral reflux in normal infants and children. Z Kinderheilkd 100:185–191PubMedCrossRefGoogle Scholar
  4. 4.
    Atala A, Keating MA (1998) Vesicoureteral reflux and megaureter. In: AJ Campbell’s Urology, 7th edn. Saunders, Philadelphia, pp 1859–1916Google Scholar
  5. 5.
    Jodal U, Lindberg U (1999) Guidelines for management of children with urinary tract infection and vesico-ureteric reflux. Recommendations from a Swedish state-of-the-art conference. Swedish Medical Research Council. Acta Paediatr Suppl 88:87–89PubMedCrossRefGoogle Scholar
  6. 6.
    Working Group of the Research Unit, Royal College of Physicians (1991) Guidelines for the management of acute urinary tract infection in childhood. Report of a Working Group of the Research Unit, Royal College of Physicians. J R Coll Physicians Lond 25:36–42Google Scholar
  7. 7.
    Elder JS, Peters CA, Arant BS Jr, Ewalt DH, Hawtrey CE, Hurwitz RS, Parrott TS, Snyder HM 3rd, Weiss RA, Woolf SH, Hasselblad V (1997) Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol 157:1846–1851PubMedCrossRefGoogle Scholar
  8. 8.
    Committee on Quality Improvement Subcommittee on Urinary Tract Infection (1999) Practice parameter: the diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. American Academy of Pediatrics. Committee on Quality Improvement. Subcommittee on Urinary Tract Infection. Pediatrics 103:843–852Google Scholar
  9. 9.
    Dick PT, Feldman W (1996) Routine diagnostic imaging for childhood urinary tract infections: a systematic overview. J Pediatr 128:15–22PubMedCrossRefGoogle Scholar
  10. 10.
    Baumer JH (2006) Can we predict vesicoureteric reflux? Arch Dis Child 91:210–211PubMedCrossRefGoogle Scholar
  11. 11.
    Elder JS (2005) Imaging for vesicoureteral reflux—is there a better way? J Urol 174:7–8PubMedCrossRefGoogle Scholar
  12. 12.
    Stefanidis CJ, Siomou E (2007) Imaging strategies for vesicoureteral reflux diagnosis. Pediatr Nephrol 22:937–947PubMedCrossRefGoogle Scholar
  13. 13.
    Smith DR (1970) Urology, 3rd edn. Saunders, Philadelphia, pp 349–397Google Scholar
  14. 14.
    Jones BW, Headstream JW (1958) Vesicoureteral reflux in children. J Urol 80:114–115PubMedGoogle Scholar
  15. 15.
    Gibson HM (1949) Ureteral reflux in the normal child. J Urol 62:40–43PubMedGoogle Scholar
  16. 16.
    Sargent MA (2000) What is the normal prevalence of vesicoureteral reflux? Pediatr Radiol 30:587–593PubMedCrossRefGoogle Scholar
  17. 17.
    Bellinger MF, Duckett JW (1984) Vesicoureteral reflux: a comparison of non-surgical and surgical management. Contrib Nephrol 39:81–93PubMedGoogle Scholar
  18. 18.
    Pirker ME, Colhoun E, Puri P (2006) Renal scarring in familial vesicoureteral reflux: is prevention possible? J Urol 176:1842–1846PubMedCrossRefGoogle Scholar
  19. 19.
    Tombesi M, Ferrari CM, Bertolotti JJ (2005) Renal damage in refluxing and non-refluxing siblings of index children with vesicoureteral reflux. Pediatr Nephrol 20:1201–1202PubMedCrossRefGoogle Scholar
  20. 20.
    Ataei N, Madani A, Esfahani ST, Kejbafzadeh A, Ghaderi O, Jalili S, Sharafi B (2004) Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux. Pediatr Nephrol 19:1127–1131PubMedGoogle Scholar
  21. 21.
    Parekh DJ, Pope JC, Adams MC, Brock JW III (2002) Outcome of sibling vesicoureteral reflux. J Urol 167:283–284PubMedCrossRefGoogle Scholar
  22. 22.
    Askari A, Belman AB (1982) Vesicoureteral reflux in black girls. J Urol 127:747–748PubMedGoogle Scholar
  23. 23.
    Farhat W, McLorie G, Geary D, Capolicchio G, Bagli D, Merguerian P, Khoury A (2000) The natural history of neonatal vesicoureteral reflux associated with antenatal hydronephrosis. J Urol 164:1057–1060PubMedCrossRefGoogle Scholar
  24. 24.
    Garin EH, Campos A, Homsy Y (1998) Primary vesicoureteral reflux: review of current concepts. Pediatr Nephrol 12:249–256PubMedCrossRefGoogle Scholar
  25. 25.
    Kohler J, Thysell H, Tencer J, Forsberg L, Hellstrom M (2001) Long-term follow-up of reflux nephropathy in adults with vesicoureteral reflux—radiological and pathoanatomical analysis. Acta Radiol 42:355–364PubMedCrossRefGoogle Scholar
  26. 26.
    Winberg J, Bollgren I, Kallenius G, Mollby R, Svenson SB (1982) Clinical pyelonephritis and focal renal scarring. A selected review of pathogenesis, prevention, and prognosis. Pediatr Clin North Am 29:801–814PubMedGoogle Scholar
  27. 27.
    Elo J, Tallgren LG, Sarna S, Alfthan O, Stenstrom R (1981) The role of vesicoureteral reflux in paediatric urinary-tract infection. Scand J Urol Nephrol 15:243–248PubMedCrossRefGoogle Scholar
  28. 28.
    Tamminen-Mobius T, Brunier E, Ebel KD, Lebowitz R, Olbing H, Seppanen U, Sixt R (1992) Cessation of vesicoureteral reflux for 5 years in infants and children allocated to medical treatment. The International Reflux Study in Children. J Urol 148:1662–1666PubMedGoogle Scholar
  29. 29.
    Ranchin B, Chapuis F, Dawhara M, Canterino I, Hadj-Aissa A, Said MH, Parchoux B, Dubourg L, Pouillaude JM, Floret D, Martin X, Cochat P (2000) Vesicoureteral reflux after kidney transplantation in children. Nephrol Dial Transplant 15:1852–1858PubMedCrossRefGoogle Scholar
  30. 30.
    Venhola M, Huttunen NP, Uhari M (2006) Meta-analysis of vesicoureteral reflux and urinary tract infection in children. Scand J Urol Nephrol 40:98–102PubMedCrossRefGoogle Scholar
  31. 31.
    Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC (2003) Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials. Arch Dis Child 88:688–694PubMedCrossRefGoogle Scholar
  32. 32.
    Wheeler DM, Vimalachandra D, Hodson EM, Roy LP, Smith GH, Craig JC (2004) Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev 3:CD001532PubMedGoogle Scholar
  33. 33.
    Craig JC, Irwig LM, Knight JF, Roy LP (2000) Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy? Pediatrics 105:1236–1241PubMedCrossRefGoogle Scholar
  34. 34.
    Lackgren G, Wahlin N, Stenberg A (1999) Endoscopic treatment of children with vesico-ureteric reflux. Acta Paediatr 88:62–71CrossRefGoogle Scholar
  35. 35.
    Uhari M, Nuutinen M, Turtinen J (1996) Adverse reactions in children during long-term antimicrobial therapy. Pediatr Infect Dis J 15:404–408PubMedCrossRefGoogle Scholar
  36. 36.
    Williams GJ, Wei L, Lee A, Craig JC (2006) Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev 3:CD001534PubMedGoogle Scholar
  37. 37.
    Mackie GG, Awang H, Stephens FD (1975) The ureteric orifice: the embryologic key to radiologic status of duplex kidneys. J Pediatr Surg 10:473–481PubMedCrossRefGoogle Scholar
  38. 38.
    Leroy S, Romanello C, Galetto-Lacour A, Smolkin V, Korczowski B, Rodrogo C, Tuerlinckx D, Gajdos V, Moulin F, Contrado M, Gervaix A, Halevy R, Duhl B, Prat C, Borght TV, Foix-l`Helias L, Dubos F, Gendrel D, Breart G, Chalumeau M (2007) Procalcitonin to reduce the number of unnecessary cystographies in children with a urinary tract infection: a European validation study. J Pediatr 150:89–95PubMedCrossRefGoogle Scholar

Copyright information

© IPNA 2008

Authors and Affiliations

  1. 1.Department of PaediatricsOulu University HospitalOuluFinland

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