Damm Tiffany, Mathews Ranjiv
Southern Illinois University Medicine, Department of Surgery, Division of Urology, 747 N. Rutledge, 5th floor Springfield, IL 62702-9665, USA.
Arch Nephrol Ren Stud. 2022;2(1):1-5.
The Randomized intervention for Vesicoureteral Reflux (RiVUR) study was an effort by the National Institute of Health to identify the most significant question on the management of vesicoureteral reflux (VUR), i.e. Did antibiotic prophylaxis reduce the incidence of recurrent urinary tract infections (UTI) in children with VUR? During the initial phases of the RiVUR study, several similar studies were performed that seemed to indicate a lack of benefit of antibiotic prophylaxis in VUR. However, few of these studies had the rigorous methodology and true randomization of the pediatric cohort that was studied in RiVUR. Additionally, many of these studies included children of wide age ranges and inconsistent assessments were used for identification of UTI and VUR. In 2011, the American Academy of Pediatrics (AAP) published a guideline statement for the evaluation of initial UTI in febrile children aged 2 to 24 months, which recommended against performing a Voiding Cystourethrogram (VCUG) in all children with a confirmed UTI. The goal of the AAP guidelines was to reduce the number of VCUGs being performed and potentially to reduce the number of children diagnosed with low grade VUR that seems to have low potential to cause renal injury. The RiVUR study included over 600 children identified with VUR after a 1 or 2 febrile UTI randomized to prophylaxis with trimethoprim/sulfamethoxazole (TMP/SMZ), or placebo and followed over a study timeline for 2 years. Overall, a 50% reduction was noted in the incidence of recurrent febrile UTI with the utilization of prophylaxis as compared to placebo. Additional sub-group analyses have been performed on the cohorts of the study; these are also evaluated in this review to determine the overall impact of the RiVUR study on the current management of VUR.
膀胱输尿管反流随机干预（RiVUR）研究是美国国立卫生研究院为确定膀胱输尿管反流（VUR）管理中最重要的问题而开展的一项研究，即抗生素预防是否能降低VUR患儿复发性尿路感染（UTI）的发生率？在RiVUR研究的初始阶段，进行了几项类似的研究，这些研究似乎表明抗生素预防对VUR没有益处。然而，这些研究中很少有像RiVUR研究那样对儿科队列进行严格的方法学和真正随机化的研究。此外，这些研究中的许多研究纳入了年龄范围广泛的儿童，并且在UTI和VUR的识别中使用了不一致的评估方法。2011年，美国儿科学会（AAP）发布了一份关于评估2至24个月发热儿童初始UTI的指南声明，建议不要对所有确诊UTI的儿童进行排尿性膀胱尿道造影（VCUG）。AAP指南的目标是减少VCUG的检查次数，并可能减少被诊断为低度VUR且似乎导致肾损伤可能性较低的儿童数量。RiVUR研究纳入了600多名在1次或2次发热性UTI后被诊断为VUR的儿童，这些儿童被随机分为接受甲氧苄啶/磺胺甲恶唑（TMP/SMZ）预防治疗或安慰剂治疗，并在2年的研究时间内进行随访。总体而言，与安慰剂相比，使用预防治疗后复发性发热性UTI的发生率降低了50%。对该研究队列进行了额外的亚组分析；本综述也对这些分析进行了评估，以确定RiVUR研究对当前VUR管理的总体影响。
