Bundovska-Kocev Smiljana, Kuzmanovska Dafina, Selim Gjulsen, Georgievska-Ismail Ljubica
University Clinic of Radiotherapy & Oncology, Medical School, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia.
University Paediatric Clinic, Medical School, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia.
Open Access Maced J Med Sci. 2019 Jan 14;7(1):107-113. doi: 10.3889/oamjms.2019.078. eCollection 2019 Jan 15.
Triad of childhood vesicoureteral reflux (VUR), urinary infection (UTI) and renal scarring might initiate potentially serious consequences that lead to renal dysfunction manifested at the second or third decade of life.
To identify the risk factors predictive for renal dysfunction in adults with primary VUR after long-term follow-up.
We evaluated the records of 101 children (94.1% female, 5.9% male) at a median age of 5.2 ± 2.3 years (1-12 years), suffering from UTI and VUR. The patients were interviewed after mean 21 years from the first episodes of VUR (8 to 32 years). Renal function was determined from the estimated glomerular filtration rate (eGFR).
Renal scarring was detected in 68.3% out of 82 patients and bilateral one in 7.3% patients. Linear regression analysis revealed that presence of proteinuria (B = -33.7, p=0.0001), the greater number of years from VUR diagnosis (B = -1.6, p = 0.002) and renal scarring (B = -14.8, p = 0.005) appeared as independent predictors of reduced global eGFRcreat. The same variables plus microalbuminuria (B = -1.0, p = 0.012) appeared as independent predictors of reduced global eGFRcreat-cys. Bilateral scarring (OR=25.5, p = 0.003) appeared as independent predictor of greater risk for CKD assessed using eGFRcreat while greater number of years from VUR diagnosis (OR = 1.7, p = 0.092), microalbuminuria (OR = 1.3, p = 0.047) and again bilateral scarring (OR = 31.3, p = 0.040) appeared as predictors of risk for CKD assessed using eGFRcreat-cys.
Identification of those with an increased risk of progression to CKD should be the goal in all patients with childhood VUR. Their systematic follow-up should be till adulthood and older age.
儿童膀胱输尿管反流（VUR）、泌尿系统感染（UTI）和肾瘢痕形成三联征可能引发潜在的严重后果，导致在生命的第二个或第三个十年出现肾功能障碍。
确定长期随访后原发性VUR成人患者肾功能障碍的预测危险因素。
我们评估了101例儿童（女性占94.1%，男性占5.9%）的记录，这些儿童中位年龄为5.2±2.3岁（1至12岁），患有UTI和VUR。患者在首次出现VUR平均21年后（8至32岁）接受访谈。通过估算肾小球滤过率（eGFR）来确定肾功能。
82例患者中有68.3%检测到肾瘢痕形成，7.3%的患者为双侧肾瘢痕形成。线性回归分析显示，蛋白尿的存在（B=-33.7，p=0.0001）、距VUR诊断的年数增加（B=-1.6，p=0.002）和肾瘢痕形成（B=-14.8，p=0.005）是全球估算肌酐清除率（eGFRcreat）降低的独立预测因素。相同的变量加上微量白蛋白尿（B=-1.0，p=0.012）是全球胱抑素C估算肌酐清除率（eGFRcreat-cys）降低的独立预测因素。双侧瘢痕形成（OR=25.5，p=0.003）是使用eGFRcreat评估的慢性肾脏病（CKD）风险更高的独立预测因素，而距VUR诊断的年数增加（OR=1.7，p=0.092）、微量白蛋白尿（OR=1.3，p=0.047）以及再次出现的双侧瘢痕形成（OR=31.3，p=0.040）是使用eGFRcreat-cys评估的CKD风险预测因素。
识别那些进展为CKD风险增加的患者应是所有儿童VUR患者的目标。应系统地对他们进行随访直至成年和老年。
