Evaluation of renal functional reserve in primary vesicoureteric reflux: A cross-sectional study.

IF 2.2 3区医学 Q2 PEDIATRICS

Journal of Pediatric Urology Pub Date : 2026-09-21 DOI:10.1016/j.jpurol.2026.106293

Sukumar Ettiappan, Bobbity Deepthi, Madhusudhanan Ponnusamy, Bikash Kumar Naredi, Sudarsan Krishnasamy, Sriram Krishnamurthy

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引用次数: 0

Abstract

Background: The role of renal functional reserve (RFR) in children with vesicoureteric reflux (VUR) is understudied. The objective of this study was to determine RFR [assessed by Diethylenetriaminepentaacetic acid (DTPA) scan] in patients aged 2-18 years with primary VUR.

Methods: This cross-sectional study evaluated RFR in 50 children with primary VUR. Baseline and stimulated (after 1 g/kg protein meal) GFR were measured using technetium-99m (Tc-99m) DTPA plasma clearance (Russell's two-sample method). RFR was calculated as the proportional GFR increase, with >10% defined as positive RFR and compared across grades of VUR and scars. RFR was also assessed by timed urinary creatinine clearance.

Results: The median age at RFR estimation was 4.3 [IQR:2.9, 8.1] years, while median age-at-diagnosis was 7 [2, 24] months. The median duration of illness was 3.6 [2.3, 6.2] years. Initial presentations included urinary tract infections (UTI) in 31 (62%) children and antenatal hydronephrosis in 18 (36%), with 90% (n = 45) having a history of prior pyelonephritis. Patients were categorized by VUR severity: unilateral low-grade (n = 7; 14%), unilateral high-grade (n = 14; 28%), bilateral high-grade (n = 26; 52%), and bilateral low-grade (n = 3; 6%). The median DTPA RFR was 13.67 [5.84, 28.27]%, with 60% (n = 30) demonstrating a positive RFR. RFR compared among children with low-grade vs high-grade VUR, demonstrated no statistically significant difference (p = 0.28). DTPA-RFR correlated weakly with timed creatinine clearance RFR (r = 0.20), which consistently overestimated RFR. The median-annual-decline rate was higher in group with absent RFR (-4.2 vs improvement of 18.25 mL/min/1.73 m²/year), with a median difference of 22.45 mL/min/1.73 m²/year (bootstrap 95% CI 4.58, 60.74), p = 0.011.

Conclusions: In conclusion, preserved RFR was noted in nearly two-thirds of children with VUR, with no significant difference with disease severity. The study demonstrates that RFR can be measured using different methodologies in children with VUR and provides valuable feasibility data.

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原发性膀胱输尿管反流的肾功能储备评估：一项横断面研究。

背景：肾功能储备（RFR）在膀胱输尿管反流（VUR）患儿中的作用尚不清楚。本研究的目的是确定2-18岁原发性VUR患者的RFR[通过二乙烯三胺五乙酸（DTPA）扫描评估]。方法：本横断面研究评估了50例原发性VUR患儿的RFR。使用锝-99m (Tc-99m) DTPA血浆清除率（罗素双样品法）测量基线和刺激（1 g/kg蛋白粉后）GFR。RFR按GFR的比例增加来计算，bbb10 %定义为阳性RFR，并比较不同级别的VUR和疤痕。RFR也通过定时尿肌酐清除率进行评估。结果：RFR估计时的中位年龄为4.3 [IQR:2.9, 8.1]岁，而诊断时的中位年龄为7[2,24]个月。中位病程为3.6年[2.3,6.2]年。最初的症状包括31名（62%）儿童的尿路感染（UTI）和18名（36%）儿童的产前肾积水，其中90% （n = 45）有肾盂肾炎病史。患者按VUR严重程度分类：单侧低级别（n = 7; 14%）、单侧高级别（n = 14; 28%）、双侧高级别（n = 26; 52%）和双侧低级别（n = 3; 6%）。中位DTPA RFR为13.67[5.84,28.27]%，其中60% （n = 30）显示RFR阳性。低级别与高级别VUR患儿的RFR比较，无统计学差异（p = 0.28）。DTPA-RFR与定时肌酐清除率RFR相关性较弱（r = 0.20），一致高估RFR。无RFR组的中位年下降率更高（-4.2 vs改善18.25 mL/min/1.73 m2/年），中位差异为22.45 mL/min/1.73 m2/年（bootstrap 95% CI 4.58, 60.74）， p = 0.011。结论：近三分之二的VUR患儿存在RFR保留，与疾病严重程度无显著差异。该研究表明，可以使用不同的方法测量VUR儿童的RFR，并提供了有价值的可行性数据。

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

Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY

CiteScore

3.70

自引率

15.00%

发文量

330

审稿时长

4-8 weeks

期刊介绍： The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.