Vesicoureteral reflux: Risk factors for renal scarring

Abstract

Background: The acquired reflux nephropathy (RN) is the common complication of vesico-ureteral reflux (VUR). The aim of this study was to determine predictive risk factors for RN using clinical, biological and radiological variables present at onset of the disease. It may be useful to adapt the therapeutic strategy.

Methods: Retrospective hospital-based cohort study in the Department of Pediatric Nephrology of Charles Nicolle, Tunis (January 2000-December 2012) included 111 children with primary VUR aged from 1 month to 12 years, followed for at least one year and have had 99m technetium dimercapto-succinic acid scintigraphy (DMSA) at least three months after urinary tract infection (UTI).

Results: A total of 111 children with primary VUR, with a median age of 4.2 years were studied. Male to female ratio was 2,71Grade I, II, III, IV and V was found in19 (20.7%), 33(28.8%), 19 (17.1%), 23 (20.7%) and 17 (12.7%) children, respectively. Renal scarring was detected in 41 (36.9%) children. Risk factors for RN identified from univariate analysis were the age (p=0.0005), abdominal pain in UTI (p=0.0004), leukocytosis (p=0.0001), CRP ≥10 mg/dl (p=0.0012) and high-grade VUR (p=0.0001). Logistic regression revealed that CRP ≥10 mg/dl (p=0.013), the white blood cell count > 10000/mm³ (p=0.046), the older age (p=0.009), abdominal pain in UTI (p=0.021), high-grade VUR (p=0.032) were independent risk factors for RN.

Conclusion: CRP ≥10 mg/dl, the white blood cell count > 10000/mm³, the older age (p=0.009), abdominal pain in UTI (p=0.021), high-grade VUR are independent risk factors for renal scars.

Keywords: Vesico-ureteral reflux, childhood, renal scarring, urinary tract infection