Summary
The prevention of reflux nephropathy by screening will likely prove to be an elusive aim. Possible non-invasive screening tests include urinary analysis for microproteins, colour Doppler ultrasound and real-time ultrasound. However, it is likely that real-time ultrasound, in practice the only feasible screening tool, would fail to detect the large group of children whose vesicoureteric reflux (VUR) does not give rise to detectable dilatation. Routine ultrasound scanning of the fetal urinary tract in pregnancy constitutes a de facto screening programme. However, it has become apparent that prenatal ultrasound results in the detection of high-grade VUR in a population of boys rather than in the numerically more important population at risk: girls with low-grade VUR. Investigating infants with mild pelvic and pelvicaliceal dilatation for VUR might improve the sensitivity of prenatal ultrasound as a screening test, but the potential benefits of detecting VUR in this group of infants would have to be weighed against unnecessary micturating cystography in a large number of normal children. Presently, considerable clinical and experimental evidence indicates that urinary infection plays the major role in the aetiology of reflux nephropathy. By detecting asymptomatic VUR in early childhood, an effective screening programme could be expected to reduce the considerable burden of morbidity that is associated with the condition. Unfortunately, a reliable screening test remains a distant goal.
Similar content being viewed by others
References
Anderson PAM, Rickwood AMK (1991) Features of primary vesicoureteric reflux detected by prenatal sonography. Br J Urol 67:267–271
Broyer M, Rizzoni G, Brunner FP et al (1985) Combined report on regular dialysis and transplantation of children in Europe. Proc EDTA 22:55–79
Chitty LS, Hunt GH, Moore J, Lobb MO (1991) Effectiveness of routine ultrasonography in a low risk population. BMJ 303:1165–1169
Decter RM, Roth DR, Gonzales ET (1988) Vesicoureteral reflux in boys. J Urol 140:1089–1091
De Sweit M, Dillon MJ (1989) Hypertension in children. BMJ 299:469–470
Editorial (1991) Prevention of reflux nephoropathy. Lancet 338:1050
Gordon AC, Thomas DFM, Arthur RJ, Irving HC, Smith SEW (1991) Prenatally diagnosed reflux: a follow-up study. Br J Urol 65:407–412
Hanbury DC, Calvin J (1991) Proteinuria and enzymuria in vesicoureteric reflux. Br J Urol (in press)
Hanbury DC, Coulden RA, Farman P, Sherwood T (1990) Ultrasound cystography in the diagnosis of vesicoureteric reflux. Br J Urol 65:250–253
Helin I, Persson PH (1986) Prenatal diagnosis of urinary tract abnormalities by ultrasound. Pediatrics 78:879–883
Jacobson SH, Eklof O, Eriksson CG, Lins LE et al (1989) Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ 299:703–706
Kincaid-Smith P (1972) The prevention of renal failure. Proc Int Congr Nephrol 3:100–118
Kincaid-Smith P (1983) Reflux nephropathy. BMJ 286:2002–2003
Lenaghan D, Whitaker JG, Jensen F, Stephens FD (1976) The natural history of reflux and long-term effects of reflux on the kidney. J Urol 115:728–730
Livera LN, Brookfield DSK, Eginton JA, Hawnaure JM (1989) Antenatal ultrasonography to detect fetal renal abnormalities: a prospective screening programme. BMJ 298:1421–1423
Marshall JL, Johnson ND, De Campo MP (1990) Vesicoureteric reflux in children: prediction with color Doppler imaging. Radiology 175:355–358
Martinell J, Jodal U, Lidin-Janson G (1990) Pregnancies in women with and without renal scarring after urinary infections in childhood. BMJ 300:840–844
Newell SJ, Morgan MEI, McHugo JM, White RHR, Taylor CM et al (1990) Clinical significance of antenatal calyceal dilation detected by ultrasound. Lancet 336:372
Schulman CC, Hall M, Collier F, Avni EF (1991) Fetal vesicoureteric reflux: diagnosis and management. J Urol 145:301A
Scott JES (1987) Fetal ureteric reflux. Br J Urol 59:291–296
Sheridan M, Jewkes F, Gough DCS (1991) Reflux nephropathy in the 1st year of life — the role of infection. Pediatr Surg Int 6:214–216
Sherwood T, Whitaker RH (1984) Initial screening of children with urinary tract infections: is plan film radiography and ultrasonography enough? BMJ 288:827
Skoog SJ, Belman AB, Majd M (1987) A nonsurgical approach to the management of primary vesicoureteral reflux. J Urol 138:941–946
Smellie JM, Edwards D, Normand ECS, Prescod N (1981) Effect of vesicoureteric reflux on renal growth in children with urinary tract infection. Arch Dis Child 56:593–600
Steele BT, Robitaille P, De Maria J, Grignon A (1989) Follow up evaluation of prenatally recognized vesicoureteric reflux. J Pediatr 115:95–96
Wallace DM, Rothwell DL, Williams DI (1978) The long term follow-up of surgically treated vesico ureteric reflux. Br J Urol 50:479–484
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Thomas, D.F.M. Non-invasive screening for vesicoureteric reflux: a realistic aim?. World J Urol 10, 80–84 (1992). https://doi.org/10.1007/BF00183139
Issue Date:
DOI: https://doi.org/10.1007/BF00183139