Houle Anne-Marie, Cheikhelard Alaa, Barrieras Diego, Rivest Marie-Christine, Gaudreault Valérie
Urology Division, Hôpital Sainte-Justine, Montreal, Quebec, Canada.
BJU Int. 2004 Jul;94(1):123-5. doi: 10.1111/j.1464-4096.2004.04872.x.
To assess the impact of screening siblings after detecting significant vesico-ureteric reflux (VUR) and renal scarring, as such screening might identify patients with VUR before urinary tract infections develop, but might also detect clinically insignificant VUR.
We used a previously reported screening protocol to assess the clinical characteristics of patients, including the incidence of renal scarring, and their siblings, and compared the results. In all, 123 children were screened and 44 (36%) had VUR on voiding cystography. The median (range) age at screening was 9 (1-90) months.
The grades of VUR detected were < III in 61% and > or = III in 39%; VUR was bilateral in 48%. In all, 37 siblings with VUR were assessed by ultrasonography; 70% were normal, including 12 (32%) children with VUR of grade > or = III. When used, renal scintigraphy was normal in 74% of siblings, vs 18% of index patients. However, when screened after 2 years old, siblings had twice the risk of already having renal damage on renal scintigraphy (P = 0.04).
Early screening (< or = 2 years) appears to be more protective for avoiding renal damage than screening older patients. Thus we propose early screening in asymptomatic siblings to detect VUR before it becomes clinically significant.
评估在检测到显著的膀胱输尿管反流（VUR）和肾瘢痕形成后对同胞进行筛查的影响，因为这种筛查可能在尿路感染发生之前识别出VUR患者，但也可能检测到临床上无意义的VUR。
我们使用先前报道的筛查方案来评估患者及其同胞的临床特征，包括肾瘢痕形成的发生率，并比较结果。总共对123名儿童进行了筛查，其中44名（36%）在排尿性膀胱造影检查中发现有VUR。筛查时的中位（范围）年龄为9（1 - 90）个月。
检测到的VUR分级中，<Ⅲ级的占61%，≥Ⅲ级的占39%；VUR为双侧的占48%。总共对37名有VUR的同胞进行了超声检查；70%结果正常，其中包括12名（32%）VUR分级≥Ⅲ级的儿童。使用肾闪烁扫描时，74%的同胞结果正常，而索引患者中这一比例为18%。然而，在2岁以后进行筛查时，同胞在肾闪烁扫描中已出现肾损害的风险是索引患者的两倍（P = 0.04）。
早期筛查（≤2岁）似乎比筛查年龄较大的患者更能预防肾损害。因此，我们建议对无症状的同胞进行早期筛查，以在VUR具有临床意义之前检测到它。
