Predictors of renal scar in children with urinary infection and vesicoureteral reflux


We evaluated the predictors of renal scar in children with urinary tract infections (UTIs) having primary vesicoureteral reflux (VUR). Data of patients who were examined by dimercaptosuccinic acid (DMSA) scintigraphy between 1995 and 2005 were evaluated retrospectively. Gender, age, reflux grade, presence/development of scarring, breakthrough UTIs, and resolution of reflux, were recorded. The relation of gender, age and VUR grade to preformed scarring and the relation of gender, age, VUR grade, presence of preformed scarring, number of breakthrough UTIs and reflux resolution to new scarring were assessed. There were 138 patients [male/female (M/F) 53/85]. Multivariate analysis showed that male gender [odds ratio (OR) 2.5], age ≥ 27 months in girls (OR 4.2) and grades IV–V reflux (OR 12.4) were independent indicators of renal scarring. On the other hand, only the presence of previous renal scarring was found to be an independent indicator for the development of new renal scar (OR 13.4). In conclusion, while the most predictive variables for the presence of renal scarring among children presenting with a UTI were male gender, age ≥ 27 months in girls, and grades IV–V reflux, the best predictor of new scar formation was presence of previous renal scarring.

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  1. 1.

    Beetz R (2006) May we go on with antibacterial prophylaxis for urinary tract infections? Pediatr Nephrol 21:5–13

    CAS  Article  Google Scholar 

  2. 2.

    Wennerström M, Hansson S, Jodal U, Stokland E (2000) Primary and acquired renal scarring in boys and girls with urinary tract infection. J Pediatr 136:30–34

    Article  Google Scholar 

  3. 3.

    Jodal U, Smellie JM, Lax H, Hoyer PF (2006) Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children. Pediatr Nephrol 21:785–792

    Article  Google Scholar 

  4. 4.

    Tamminen-Möbius T, Brunier E, Ebel KD, Lebowitz R, Olbing H, Seppanen U, Sixt R (1992) Cessation of vesicoureteral reflux for 5 years in infants and children allocated to medical treatment. International Reflux Study in Children. J Urol 148:1662–1666

    Article  Google Scholar 

  5. 5.

    Wheeler D, Vimalachandra D, Hodson EM, Roy LP, Smith G, Craig JC (2003) Antibiotics and surgery for vesicoureteric reflux: a meta-analysis of randomised controlled trials. Arch Dis Child 88:688–694

    CAS  Article  Google Scholar 

  6. 6.

    Linshaw MA (1999) Controversies in childhood urinary tract infections. World J Urol 17:383–395

    CAS  Article  Google Scholar 

  7. 7.

    Garin EH, Olavarria F, Garcia Nieto V, Valenciano B, Campos A, Young L (2006) Clinical significance of primary vesicoureteral reflux and urinary antibiotic prophylaxis after acute pyelonephritis: a multicenter, randomized, controlled study. Pediatrics 117:626–632

    Article  Google Scholar 

  8. 8.

    Polito C, Rambaldi PF, Signoriello G, Mansi L, La Manna A (2006) Permanent renal parenchymal defects after febrile UTI are closely associated with vesicoureteric reflux. Pediatr Nephrol 21:521–526

    Article  Google Scholar 

  9. 9.

    Jacobson SH, Eklof O, Eriksson CG, Lins LE, Tidgren B, Winberg J (1989) Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. BMJ 299:703–706

    CAS  Article  Google Scholar 

  10. 10.

    Zhang Y, Bailey RR (1995) A long term follow up of adults with reflux nephropathy. N Z Med J 108:142–144

    CAS  PubMed  Google Scholar 

  11. 11.

    Ardissino G, Dacco V, Testa S, Bonaudo R, Claris-Appiani A, Taioli E, Marra G, Edefonti A, Sereni F, ItalKid Project (2003) Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics 111:e382–387

    Article  Google Scholar 

  12. 12.

    Seikaly MG, Ho PL, Emmett L, Fine RN, Tejani A (2003) Chronic renal insufficiency in children: the 2001 Annual Report of the NAPRTCS. Pediatr Nephrol 18:796–804

    Article  Google Scholar 

  13. 13.

    Sirin A, Emre S, Alpay H, Nayir A, Bilge I, Tanman F (1995) Etiology of chronic renal failure in Turkish children. Pediatr Nephrol 9:549–552

    CAS  Article  Google Scholar 

  14. 14.

    International Reflux Study Committee (1981) Medical versus surgical treatment of primary vesicoureteral reflux. Pediatrics 67:392–400

    Google Scholar 

  15. 15.

    Marra G, Oppezzo C, Ardissino G, Dacco V, Testa S, Avolio L, Taioli E, Sereni F, Italkid Project (2004) Severe vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the Italkid Project. J Pediatr 144:677–681

    Article  Google Scholar 

  16. 16.

    Caione P, Villa M, Capozza N, De Gennaro M, Rizzoni G (2004) Predictive risk factors for chronic renal failure in primary high-grade vesico-ureteric reflux. BJU Int 93:1309–1312

    CAS  Article  Google Scholar 

  17. 17.

    Silva JMP, Diniz JSS, Silva ACS, Azevedo MV, Pimenta MR, Oliveira EA (2006) Predictive factors of chronic kidney disease in severe vesicoureteral reflux. Pediatr Nephrol 21:1285–1292

    Article  Google Scholar 

  18. 18.

    Burns MW, Burns JL, Krieger JN (1987) Pediatric urinary tract infection. Diagnosis, classification and significance. Pediatr Clin North Am 34:1111–1120

    CAS  Article  Google Scholar 

  19. 19.

    Lebowitz RL, Olbing H, Parkkulainen KV, Smellie JM, Tamminen-Möbius TE (1985) International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children. Pediatr Radiol 15:105–109

    CAS  Article  Google Scholar 

  20. 20.

    Caione P, Ciofetta G, Collura G, Morano S, Capozza N (2004) Renal damage in vesico-ureteric reflux. BJU Int 93:591–595

    CAS  Article  Google Scholar 

  21. 21.

    Mattoo TK (2007) Medical management of vesicoureteral reflux. Pediatr Nephrol 22:1113–1120

    Article  Google Scholar 

  22. 22.

    Jakobsson B, Nolstedt L, Svensson L, Söderlundh S, Berg U (1992) 99 mTc-dimercaptosuccinic acid (DMSA) scan in the diagnosis of acute pyelonephritis in children: relation to clinical and radiological findings. Pediatr Nephrol 6:328–334

    CAS  Article  Google Scholar 

  23. 23.

    Silva JM, Santos Diniz JS, Marino VS, Lima EM, Cardoso LS, Vasconcelos MA, Oliveira EA (2006) Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 21:981–988

    Article  Google Scholar 

  24. 24.

    Simoes e Silva AC, Silva JM, Diniz JS, Pinheiro SV, Lima EM, Vasconcelos MA, Pimenta MR, Oliveira EA (2007) Risk of hypertension in primary vesicoureteral reflux. Pediatr Nephrol 22:459–462

    Article  Google Scholar 

  25. 25.

    Lee JH, Son CH, Lee MS, Park YS (2006) Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol 21:1281–1284

    Article  Google Scholar 

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Correspondence to Alper Soylu.

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Soylu, A., Demir, B.K., Türkmen, M. et al. Predictors of renal scar in children with urinary infection and vesicoureteral reflux. Pediatr Nephrol 23, 2227–2232 (2008).

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  • Urinary tract infection
  • Vesicoureteral reflux
  • Renal scar