Intrarenal reflux is linked to subsequent kidney scarring: a retrospective study.

IF 2.6 3区医学 Q1 PEDIATRICS

Pediatric Nephrology Pub Date : 2025-10-01 Epub Date: 2025-05-24 DOI:10.1007/s00467-025-06820-3

Jisun Hwang, Su Jin Lee, Ki Soo Pai, Peong Gang Park

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引用次数: 0

Abstract

Background: This study investigates whether intrarenal reflux (pyelotubular backflow) is associated with kidney scarring in children with urinary tract infection (UTI).

Methods: We retrospectively reviewed 441 children diagnosed with UTI who underwent voiding cystourethrography (VCUG) and a technetium-99 m dimercaptosuccinic acid (DMSA) scan more than 3 months after the UTI. Intrarenal reflux was identified on VCUG. Using multivariable logistic regression, we analyzed the association between intrarenal reflux and kidney scarring on DMSA scans, adjusting for vesicoureteral reflux (VUR) grade and other clinical variables.

Results: Out of 874 kidney units, VUR was detected in 255 units (29.1%), with intrarenal reflux present in 35 units (13.7%). Kidney scarring was observed in 12.7% of all kidney units. Intrarenal reflux was significantly associated with an increased risk of kidney scarring (odds ratio 3.35, 95% confidence interval 1.31-8.58) after adjusting for VUR grade. Notably, 92% of photon defects on DMSA scans in units with intrarenal reflux were located at the reflux site.

Conclusions: Intrarenal reflux is an independent predictor of kidney scarring beyond conventional VUR grading. Recognizing and reporting intrarenal reflux during VUR assessment may aid in developing tailored management strategies for children with UTI and VUR.

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肾内反流与随后的肾瘢痕形成有关：一项回顾性研究

背景：本研究探讨尿路感染（UTI）患儿肾内反流（肾盂小管反流）是否与肾瘢痕形成相关。方法：我们回顾性分析了441名被诊断为UTI的儿童，他们在UTI发生3个多月后接受了排尿膀胱尿道造影（VCUG）和锝-99米二巯基琥珀酸（DMSA）扫描。VCUG显示肾内反流。使用多变量logistic回归，我们分析了DMSA扫描中肾内反流与肾瘢痕形成之间的关系，调整了膀胱输尿管反流（VUR）等级和其他临床变量。结果：在874个肾脏单位中，255个单位（29.1%）检测到VUR， 35个单位（13.7%）存在肾内反流。12.7%的肾单位出现肾瘢痕。经VUR分级调整后，肾内反流与肾瘢痕形成风险增加显著相关（优势比3.35,95%可信区间1.31-8.58）。值得注意的是，在肾内反流单位的DMSA扫描中，92%的光子缺陷位于反流部位。结论：肾内反流是传统VUR分级之外的肾瘢痕形成的独立预测因子。在VUR评估中识别和报告肾内反流可能有助于为UTI和VUR患儿制定量身定制的管理策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Nephrology 医学-泌尿学与肾脏学

CiteScore

4.70

自引率

20.00%

发文量

465

审稿时长

1 months

期刊介绍： International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.