Impact of Urinary Tract Infection on Progression of Renal Scars and Formation of New Scars in Patients with Primary Vesicoureteric Reflux.

Ahmad Md Sohail, Amit Kumar Satapathy, Kanhaiyalal Agrawal, Kanishka Das, Akash Bihari Pati
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Abstract

Introduction: 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.

Materials and methods: 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).

Results: 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).

Conclusion: 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.

尿路感染对原发性膀胱输尿管反流患者肾瘢痕进展和新瘢痕形成的影响
导言:原发性膀胱输尿管反流(VUR)是导致儿童终末期肾衰竭的常见原因。放射性核素成像上的疤痕表明成长中的肾脏受到了无法弥补的损害。本研究旨在确定与原发性输尿管返流相关的尿路感染(UTI)是否会促进新肾脏疤痕的形成或原有疤痕的恶化:在一家三级甲等教学医院的儿科肾脏泌尿科门诊对持续服用抗生素预防的原发性尿崩症患儿进行了前瞻性观察。入院时进行肾皮质(二巯基丁二酸 [DMSA])扫描,每 3 个月对患儿进行随访。记录突破性UTI,并进行后续DMSA扫描,以记录肾输尿管单元(RUU)中新出现的瘢痕/现有瘢痕的升级:结果:对 36 名患者的 72 个输尿管单元进行了监测。54个(75%)RUU暴露于不同等级的VUR,46个(85.1%)有UTI。在 DMSA 扫描中,10/18(55%)个 RUU 显示新疤痕形成,13/28(46.4%)个 RUU 显示疤痕进展。在 8 个有 VUR 但没有 UTI 的 RUU 中,4/5(80%)的 RUU 出现了新疤痕,1/3(33%)的 RUU 出现了疤痕进展。经单变量分析,有 VUR 和 UTI 的 RUU 与无 UTI 的 RUU 在 DMSA 扫描中新疤痕的形成或疤痕进展方面无明显差异。DMSA 扫描显示的疤痕与反流程度呈明显正相关(P < 0.001):结论:无论泌尿系统感染与否,原发性 VUR 患者都有新的或进展中的瘢痕。结论:无论泌尿系统感染与否,原发性 VUR 患者都会出现新的或进展中的瘢痕。
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