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Renal Cortical Abnormalities In Siblings Of Index Patients With Vesicoureteral Reflux
Manuela Hunziker, MD, Prem Puri, FRCS.
National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland.

Introduction: The familial nature of vesicoureteral reflux (VUR) is well recognized. Several studies have shown that siblings of children with VUR are at much higher risk to have reflux than the general pediatric population with a reported prevalence between 26% and 50%. One of the main goals of treating the child with VUR is prevention of recurring febrile UTIs and minimizing the risk of renal damage and long term renal impairment. Screening siblings of index patients with VUR has been proposed to identify children who are at risk. However, with little information on observational familial VUR studies, screening siblings for VUR remains controversial. We investigated the risks of VUR and renal cortical abnormalities in the sibling population in a large cohort of families with VUR.
Material and Methods: After ethical approval from our Institution, parents of index patients with grade III to V VUR were asked permission to screen siblings who were younger than 6 years of age. VUR was diagnosed in all siblings by voiding cystourethrogram (VCUG) and graded according to the International Classification Systems. Siblings were divided into two groups: Siblings with a documented history of a prior urinary tract infection (UTI) and siblings who were screened for VUR and never had a UTI. Dimercaptosuccinic acid (DMSA) scan was performed to assess renal cortical abnormalities. A logistic regression model was used to determine independent risk factors associated with renal cortical abnormalities such as history of presentation, age, gender and grade of VUR.
Results: There were 318 siblings in 275 families in the study. Families with 2, 3, 4, and 5 affected siblings were 237, 34, 3 and 1, respectively. VUR was found after screening in 190 (60%) siblings and after a UTI in 128 (40%). Grade IV to V VUR was diagnosed in 147 (47%) siblings. There were 174 (55%) siblings less than 1 year of age and 144 (45%) over 1 year of age. Multivariate analysis revealed that siblings who had a previous UTI (OR:4.38 [95%Cl: 1.72-13.85], p<0.001), siblings with high grade reflux (OR:3.62 [95%Cl: 1.58-8.29], p=0.002) and siblings over 1 year of age (OR:2.84 [95%Cl: 1.30-6.19], p=0.009) were the most significant independent risk factors associated with renal cortical abnormalities.
Conclusion: There is increased risk of renal cortical abnormalities in siblings with a prior UTI, siblings with high grade VUR and siblings over the age of 1 year. This information may help to counsel parents about the risk of VUR and reflux nephropathy in familial VUR.


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