Pirker Martina E, Colhoun Eric, Puri Prem
Children's Research Centre, Our Lady's Hospital for Sick Children, Crumlin, Dublin 2, Ireland.
J Urol. 2006 Oct;176(4 Pt 2):1842-6; discussion 1846. doi: 10.1016/j.juro.2006.04.089.
Detailed knowledge about risk factors for renal scarring in familial reflux is necessary to decide whether these factors could be influenced by early screening and treatment of siblings. We evaluated the prevalence of and risk factors influencing renal scarring in familial vesicoureteral reflux.
We reviewed the medical records and dimercapto-succinic acid scans of 306 children with familial vesicoureteral reflux. Scarring was classified as mild, moderate and severe. The impact of urinary tract infections, patient sex, reflux grade and age at diagnosis on renal scarring was evaluated.
The prevalence of renal scarring was identical at 36% in 142 index patients and 74 siblings presenting with urinary tract infection but it was only 10% in 87 asymptomatic siblings (p <0.001) The difference between siblings with and without urinary tract infection was only statistically significant for mild scarring (23% vs 4.6%, p <0.001). It did not attain significance in those with moderate to severe scarring (13.5% vs 5.7%). Moderate to severe scarring was significantly more common in grade V than in grade IV refluxing units (43% vs 10%, p <0.0001) and in male than in female siblings (15.8% vs 3.4%, p = 0.012). Mild scarring was not significantly associated with reflux grade or patient sex. Children diagnosed before age 3 years showed significantly less scarring than patients diagnosed later (23% vs 41%, p <0.002).
The development of mild renal scarring seems to mainly depend on urinary tract infections, while moderate and severe scarring are also associated with high grade reflux and male sex. Early detection and treatment may prevent further urinary tract infections as well as reflux related kidney damage.
要确定家族性反流中肾瘢痕形成的危险因素是否可通过对同胞进行早期筛查和治疗来加以影响，就必须详细了解这些危险因素。我们评估了家族性膀胱输尿管反流中肾瘢痕形成的患病率及其危险因素。
我们回顾了306例家族性膀胱输尿管反流患儿的病历及二巯基丁二酸扫描结果。瘢痕分为轻度、中度和重度。评估了尿路感染、患者性别、反流分级及诊断时年龄对肾瘢痕形成的影响。
142例有症状患儿及74例有尿路感染的同胞中肾瘢痕形成的患病率均为36%，但87例无症状同胞中仅为10%（p<0.001）。有尿路感染和无尿路感染的同胞之间，仅轻度瘢痕形成差异有统计学意义（23%对4.6%，p<0.001）。中度至重度瘢痕形成者差异无统计学意义（13.5%对5.7%）。V级反流单位中度至重度瘢痕形成明显比IV级反流单位更常见（43%对10%，p<0.0001），男性同胞比女性同胞更常见（15.8%对3.4%，p=0.012）。轻度瘢痕形成与反流分级或患者性别无明显相关性。3岁前诊断的患儿瘢痕形成明显少于较晚诊断的患者（23%对41%，p<0.002）。
轻度肾瘢痕形成的发展似乎主要取决于尿路感染，而中度和重度瘢痕形成还与高级别反流及男性性别有关。早期检测和治疗可能预防进一步的尿路感染以及反流相关的肾损害。
