Sohail Ahmad Md, Satapathy Amit Kumar, Agrawal Kanhaiyalal, Das Kanishka, Pati Akash Bihari
Department of Pediatric Surgery, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Afr J Paediatr Surg. 2024 Aug 23. doi: 10.4103/ajps.ajps_141_23.
Primary vesicoureteric reflux (VUR) is a prevalent cause of end-stage renal failure in children. Scars on radionuclide imaging indicate irreparable damage to the growing kidneys. This study aims to determine whether a urinary tract infection (UTI) associated with primary VUR promotes the development of new renal scars or progression in the pre-existing ones.
Children with primary VUR on continuous antibiotic prophylaxis at a tertiary teaching hospital's paediatric nephrourology clinic were observed prospectively. At recruitment, a renal cortical (dimercaptosuccinic acid [DMSA]) scan was done, and the children were followed up every 3 months. Breakthrough UTIs were documented, and follow-up DMSA scans were performed to document new scarring/grade advancement of existing scars in the renoureteric units (RUUs).
Seventy-two RUUs in 36 patients were monitored. Fifty-four (75%) RUUs were exposed to VUR of different grades, and 46 (85.1%) had a UTI. On the DMSA scan, these showed new scar development in 10/18 (55%) RUUs and scar progression in 13/28 (46.4%) RUUs. Of the 8 RUUs with VUR and without UTI, new scars manifest in 4/5 (80%) and progressed in 1/3 (33%). On univariate analysis, there was no significant difference in the formation of new scars or scar advancement on the DMSA scan between RUU with VUR and UTI and those without UTI. There was a significant positive correlation between the scarring on DMSA scan and the grade of reflux (P < 0.001).
Primary VUR patients had fresh or progressed scarring regardless of urinary infection. A higher VUR grade at presentation was a significant risk factor for scarring.
原发性膀胱输尿管反流（VUR）是儿童终末期肾衰竭的常见病因。放射性核素成像上的瘢痕表明正在生长的肾脏受到了不可修复的损害。本研究旨在确定与原发性VUR相关的尿路感染（UTI）是否会促进新的肾瘢痕形成或使已有的肾瘢痕进展。
对一家三级教学医院儿科肾病泌尿科门诊接受持续抗生素预防治疗的原发性VUR患儿进行前瞻性观察。入组时进行了肾皮质（二巯基丁二酸[DMSA]）扫描，患儿每3个月接受一次随访。记录突破性UTI情况，并进行随访DMSA扫描，以记录肾输尿管单位（RUUs）中新瘢痕形成/现有瘢痕分级进展情况。
对36例患者的72个RUUs进行了监测。54个（75%）RUUs存在不同程度的VUR，46个（85.1%）发生了UTI。在DMSA扫描中，这些RUUs显示10/18（55%）有新瘢痕形成，13/28（46.4%）有瘢痕进展。在8个有VUR但无UTI的RUUs中，4/5（80%）出现了新瘢痕，1/3（33%）有瘢痕进展。单因素分析显示，有VUR和UTI的RUUs与无UTI的RUUs在DMSA扫描上新瘢痕形成或瘢痕进展方面无显著差异。DMSA扫描上的瘢痕与反流分级之间存在显著正相关（P < 0.001）。
原发性VUR患者无论是否发生尿路感染，均有新的瘢痕形成或瘢痕进展。就诊时较高的VUR分级是瘢痕形成的重要危险因素。
