Yan Hualin, Wu Cong, Zhou Jiehong, Huang Cairong, Ma Xue, Huang Yidong, Huang Lugang, Liu Juxian
Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.
Front Pediatr. 2024 Dec 18;12:1478436. doi: 10.3389/fped.2024.1478436. eCollection 2024.
Vesicoureteral reflux (VUR) is a common pediatric urological condition associated with renal scarring, hypertension, and chronic kidney disease. Contrast-enhanced voiding urosonography (ceVUS) has emerged as a promising technique for diagnosing and evaluating VUR, with intrarenal reflux (IRR) often detected using this method. This study aimed to explore the relationship between different VUR grades and IRR on ceVUS, and assess the impact of VUR and IRR on kidney size and function.
We reviewed all ceVUS studies from January 2019 to December 2023 conducted at West China Hospital, Sichuan University. Both video clips and digital images of the ceVUS examinations were recorded. A total of 220 uretero-renal units (URUs) of 110 children (67 males and 43 females) were included in this study.
Among the 220 URUs assessed, 134 were diagnosed with VUR, and 25 exhibited IRR, with IRR exclusively observed in patients with grade II VUR or higher. Upon age and sex matching, the severity of IRR showed a significant positive correlation with high-grade VUR ( 0.001). Notably, patients with high-grade VUR and IRR displayed reduced kidney size compared to those without VUR or IRR ( 0.05). Furthermore, patients with high-grade VUR and IRR had reduced DMSA renal function ( = 0.015, = 0.012, respectively), and patients with high-grade VUR had more DMSA scars ( = 0.027), compared with those without VUR or IRR.
Our study highlights that on ceVUS, the IRR degree was associated with the high-grade VUR, along with reductions in kidney size and renal function in patients with high-grade VUR and IRR.
膀胱输尿管反流（VUR）是一种常见的儿科泌尿系统疾病，与肾瘢痕形成、高血压和慢性肾脏病相关。对比增强排尿超声检查（ceVUS）已成为诊断和评估VUR的一种有前景的技术，常使用该方法检测肾内反流（IRR）。本研究旨在探讨ceVUS上不同VUR分级与IRR之间的关系，并评估VUR和IRR对肾脏大小和功能的影响。
我们回顾了四川大学华西医院2019年1月至2023年12月进行的所有ceVUS研究。记录了ceVUS检查的视频片段和数字图像。本研究共纳入110名儿童（67名男性和43名女性）的220个输尿管-肾单位（URU）。
在评估的220个URU中，134个被诊断为VUR，25个表现出IRR，IRR仅在II级及以上VUR患者中观察到。在年龄和性别匹配后，IRR的严重程度与高级别VUR呈显著正相关（<0.001）。值得注意的是，与无VUR或IRR的患者相比，高级别VUR和IRR患者的肾脏大小减小（<0.05）。此外，与无VUR或IRR的患者相比，高级别VUR和IRR患者的二巯基丁二酸（DMSA）肾功能降低（分别为<0.015，<0.012），高级别VUR患者有更多的DMSA瘢痕（<0.027）。
我们的研究强调，在ceVUS上，IRR程度与高级别VUR相关，且高级别VUR和IRR患者的肾脏大小和肾功能降低。
