Clinical and Laboratory ObservationsSevere vesicoureteral reflux and chronic renal failure: a condition peculiar to male gender? Data from the Italkid Project☆
Section snippets
Material and methods
The ItalKid Project is a prospective population-based registry of Italian children with CRF, which was started in 1990 with the following inclusion criteria: (1) creatinine clearance <75 mL/minute/1.73m2 according to Schwartz's formula17 (or serum creatinine more than 3 standard deviations above the mean level for sex and age in the case of children aged <1 year) and (2) an age of <20 years at the time of registration. The organizational structure of the registry, the type of available
Results
Of the 1197 patients registered in the ItalKid Project, 284 (25.7%) were affected by primary VUR: 220 of them (77.5%) were males, and their age at registration (median, 3.0 years; IR, 1.1-8.3) was significantly lower than that of the females (median, 7.9 years; IR, 3.0-11.4), whereas their creatinine clearance was not significantly different: median: 49.1 mL/minute/1.73m2 (IR, 33.0-62.8 mL/minute/1.73m2) versus 54.0 mL/minute/1.73m2 (IR, 40.2-65.0 mL/minute/1.73m2). The Table shows the major
Discussion
The fact that the ItalKid Project identifies primary VUR as a separate diagnostic category among the causes of CRF made it possible to study this group of patients in detail and to confirm that VUR is the principal cause of CRF in children.2., 4. The ItalKid data also indicate that VURs complicated by CRF mainly affect males, are generally severe, and are not currently burdened by a late diagnosis. On the other hand, it is likely that patients with a less severe grade of reflux usually will not
Acknowledgements
We thank the following for their precious cooperation: Ms S. Loi (secretary of the Italkid Project) for data management, and Mr K. Smart (Link srl) for his linguistic help in the preparation of the manuscript.
References (34)
A molecular and genetic view of human renal and urinary tract malformations
Kidney Int
(2000)- et al.
Congenital renal damage associated with primary vesicoureteral reflux detected prenatally in male infants
J Pediatr
(1994) - et al.
Reflux nephropathy secondary to intrauterine vesicoureteric reflux
J Pediatr Surg
(1990) - et al.
Follow-up evaluation of prenatally recognized vesicoureteric reflux
J Pediatr
(1989) - et al.
Chronic pyelonephritis and vesicoureteric reflux
Clin Radiol
(1960) - et al.
Vesico-ureteral reflux: role in pyelonephritis
Am J Med
(1963) - et al.
Clinical pyelonephritis and focal renal scarring: a selected review of pathogenesis, prevention, and prognosis
Pediatr Clin North Am
(1982) Vesico-ureteric reflux, urinary-tract infection, and renal damage in children
Lancet
(1995)- et al.
The natural history of reflux and long-term effects of reflux on the kidney
J Urol
(1976) - et al.
Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial
Lancet
(2001)
Outcome at 10 years of severe vesicoureteric reflux managed medically: report of the International Reflux Study in Children
J Pediatr
Role of the angiotensin type 2 receptor gene in congenital anomalies of the kidney and urinary tract, CAKUT, of mice and men
Mol Cell
Experimental reflux in the fetus depends on bladder function and causes renal fibrosis
J Urol
End-stage reflux nephropathy
Ren Fail
Epidemiology of chronic renal failure in children: data from the ItalKid Project
Pediatr
Epidemiology of chronic renal failure in children: a report from Sweden 1986-1994. Swedish Pediatric Nephrology Association
Pediatr Nephrol
The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis
Br J Urol
Cited by (95)
Automated Society of Fetal Urology (SFU) grading of hydronephrosis on ultrasound imaging using a convolutional neural network
2023, Journal of Pediatric UrologyAsian guidelines for urinary tract infection in children
2021, Journal of Infection and ChemotherapyIs endothelial glycocalyx damage a cause of renal scarring in vesicoureteral reflux with febrile urinary tract infection?
2021, Nephrologie et TherapeutiqueRadionuclide Tools in Clinical Management of Febrile UTI in Children
2020, Seminars in Nuclear MedicineEndoscopic injection for primary vesicoureteric reflux: Predictors of resolution and long term efficacy
2017, Journal of Pediatric SurgeryCitation Excerpt :The volume of Deflux injected, injection technique, surgical experience, laterality, sex, age of patients, number of UTI, breakthrough UTI, and bowel bladder dysfunction did not attain statistical significance in univariate evaluation. Vesicoureteric reflux is found in 29% to 50% of children that presented with urinary tract infections [23] and accounts for 26% of the children with chronic renal failure in a population-based registry [24]. Although spontaneous resolution may occur, the yearly resolution rate for grade IV and V VUR was only 9% [25].
The Swedish infant high-grade reflux trial: UTI and renal damage
2017, Journal of Pediatric UrologyCitation Excerpt :Renal parenchymal defects were seen in 87% of the children at baseline, with a strong correlation with the grade of VUR. The defects were more common and more severe in boys than in girls, which is in accordance with several previous reports on congenital renal dysplasia in boys versus acquired scarring due to febrile UTI in girls [4,6,7]. It is also believed that early clinical manifestation indicates a greater severity of the disease, especially in males, which can explain the high prevalence of renal defects in this study.
- ☆
The ItalKid Project is supported by a research grant from the “Associazione per il Bambino Nefropatico.”