Outcome of Vesico Ureteral Reflux in Children (VUR) and Idiopathic Hypercalciuria (IHC) associated with Urinary Tract Infection (UTI) in Indian Children
Abstract
Background: Paediatric UTI associated with predisposing factors like VUR and IHC causes severe damage to renal tissues resulting in renal scars.
Material and Methods: This prospective observational study was conducted from August 2017 to January 2019 in teaching military hospital and tertiary care corporate hospital was done to analyse and quantify the effects of these co-morbidities in Indian children with UTI.
Results: A total 405 children of UTI were studied. 55 children (13.58%) had VUR being predominantly in the age group of 1-36 months (74.54%) with majority males (58.55%). 4 children (0.98%) had IHC. 346 children or 85.43% of sample size did not show any signs of VUR or IHC. 17 male children (56.66%) and 13 female children (43.33%) had bilateral VUR. Out of the 55 children with VUR, 26 (47.27%) developed renal scars.
Conclusion: Medical management was successful in resolution of 27% of cases. All the 8 cases with Grade V VUR did not improve and required surgery. All the cases of IHC resolved spontaneously on conservative management.
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References
Shaikh N, Hoberman A, Keren R, Gotman N, Docimo SG, Maathews R, et al. Recurrent Urinary Tract Infections in Children with Bladder and Bowel Dysfunction. Pediatr. 2016;137(1):e20152982. doi: https://doi.org/10.1542/peds.2015-2982.
Blumenthal I. Vesicoureteric reflux and urinary tract infection in children. Postgra Med J. 2006;82(963):31-35. doi: http://dx.doi.org/10.1136/pgmj.2005.036327.
Garcia RM, Kirsch A. Urinary tract infection in the setting of vesicoureteral reflux. F1000Research. 2016;5:1552. doi: https://doi.org/10.12688/f1000research.8390.1.
Kliegman RM, Behrman RE, Jenson HB, Stanton BM. Urinary Tract Infections. 20/e. Nelson Textbook of Pediatrics E-Book. Elsevier Health Sciences; Philadelphia 2016;(2):pp 2556.
Subcommittee OU. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatr. 2016;138(6):e20163026. doi: https://doi.org/10.1542/peds.2016-3026.
Balestracci A, Meni Battaglia L, Toledo I, Martin SM, Wainsztein RE. Idiopathic hypercalciuria in children with urinary tract infection. Arch Argent Pediatr. 2014;112(5):428-433. doi: http://dx.doi.org/10.5546/aap.2014.428.
Elder JS, Peters CA, Arant BS, Ewalt DH, Hawtrey CE, Hurwitz RS, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol. 1997;157(5):1846-1851.
Olbing H., Claësson I., Ebel K.-D., Seppänen U., Smellie J.M., Tamminen-Möbius T., et al. Renal Scars and Parenchymal Thinning in Children with Vesicoureteral Reflux: A 5-Year Report of the International Reflux Study in Children (European Branch). J Urol. 1992 Nov 1;148(5 Part 2):1653–6. doi: https://doi.org/10.1016/S0022-5347(17)36995-1.
Brandström Per, Nevéus Tryggve, Sixt Rune, Stokland Eira, Jodal Ulf, Hansson Sverker. The Swedish Reflux Trial in Children: IV. Renal Damage. J Urol. 2010;184(1):292-297. doi: https://doi.org/10.1016/j.juro.2010.01.060.
Swerkersson S, Jodal U, Sixt R, Stokland E, Hansson S. Relationship Among Vesicoureteral Reflux, Urinary Tract Infection and Renal Damage in Children. J Urol. 2007;178(2):647-651. doi: https://doi.org/10.1016/j.juro.2007.04.004.
Caione P, Ciofetta G, Collura G, Morano S, Capozza N. Renal damage in vesico-ureteric reflux. BJU Int. 2004;93(4):591-595. doi: https://doi.org/10.1111/j.1464-410X.2003.04673.x.
Lama G, Russo M, De Rosa E, Mansi L, Piscitelli A, Luongo I, et al. Primary vesicoureteric reflux and renal damage in the first year of life. Pediatr Nephrol. 2000;15(3):205-210. doi: https://doi.org/10.1007/s004670000455.
Mattoo TK, Chesney RW, Greenfield SP, Hoberman A, Keren R, Mathews R, et al. Renal Scarring in the Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Trial. CJASN. 2016;11(1):54–61. doi: https://doi.org/10.2215/CJN.05210515.
Nacaroglu HT, Demircin G, Bülbül M, Erdogan O, Akyüz SG, Caltik A. The association between urinary tract infection and idiopathic hypercalciuria in children. Ren Fail. 2013;35(3):327-332.
Ali E-TMA, Alfaki EM, Abdelraheem MB. Primary vesicoureteral reflux in Sudanese children. Saudi J Kid Dis Transpl. 2014;25(4):900-905. doi: https://doi.org/10.4103/1319-2442.135212.
Yılmaz S, Özçakar ZB, Şükür EDK, Bulum B, Kavaz A, Elhan AH, et al. Vesicoureteral Reflux and Renal Scarring Risk in Children after the First Febrile Urinary Tract Infection. NEF. 2016;132(3):175-180. doi: https://doi.org/10.1159/000443536.
Goldman M, Bistritzer T, Horne T, Zoareft I, Aladjem M. The etiology of renal scars in infants with pyelonephritis and vesicoureteral reflux. Pediatr Nephrol. 2000;14(5):385-388. doi: https://doi.org/10.1007/s004670050779.
Howard RG, Roebuck DJ, Yeung PA, Chan KW, Metreweli C. Vesicoureteric reflux and renal scarring in Chinese children. Br J Radiol. 2001;74(880):331-334. doi: https://doi.org/10.1259/bjr.74.880.740331.
Lee JH, Son CH, Lee MS, Park YS. Vesicoureteral reflux increases the risk of renal scars: a study of unilateral reflux. Pediatr Nephrol. 2006;21(9):1281-1284. doi: https://doi.org/10.1007/s00467-006-0147-x.
Al-Ibrahim AA, Girdharilal RD, Jalal MAC, Alghamdy AH, Ghazal YK. Urinary Tract Infection and Vesicoureteral Reflux in Saudi Children. Saudi J Kid Dis Transpl. 2002;13(1):24-28.
Menon P, Rao KLN, Bhattacharya A, Mahajan JK, Samujh R. Primary vesicoureteral reflux: progress of disease, somatic growth and renal parameters. Indian Pediatr. 2004;41(10):1025-1030.
Langman CB, Moore ES. Hypercalciuria in clinical pediatrics. A review. Clin Pediatr (Phila) 1984;23(3):135-137. doi: https://doi.org/10.1177/000992288402300301.
Heiliczer JD, Canonigo BB, Bishof NA, Moore ES. Noncalculi urinary tract disorders secondary to idiopathic hypercalciuria in children. Pediatr Clin North Am. 1987;34(3):711-718. doi: https://doi.org/10.1016/S0031-3955(16)36263-0.
Letavernier E, Traxer O, Daudon M, Tligui M, Hubert-Brierre J, Guerrot D, et al. Determinants of osteopenia in male renal-stone-disease patients with idiopathic hypercalciuria. Clin J Am Soc Nephrol. 2011;6(5):1149-1154. doi: https://doi.org/10.2215/CJN.10191110.
Coe FL, Worcester EM, Evan AP. Idiopathic hypercalciuria and formation of calcium renal stones. Nat Rev Nephrol. 2016;12(9):519-533. doi: https://doi.org/10.1038/nrneph.2016.101.
Sadeghi-Bojd S, Hashemi M. Hypercalciuria and recurrent urinary tract infections among children in Zahedan, Iran. J Pak Med Assoc. 2008;58(11):624-626.
Mahyar A, Dalirani R, Ayazi P, Hamzehloo S, Moshiri SA, Khoshbakht Ahmadi N, et al. The association of hypercalciuria and hyperuricosuria with vesicoureteral reflux in children. Clin Exp Nephrol. 2017;21(1):112-116. doi: https://doi.org/10.1007/s10157-016-1236-1.
Escribano J, Balaguer A, Pagone F, Feliu A, Roqué I Figuls M. Pharmacological interventions for preventing complications in idiopathic hypercalciuria. Cochrane Database Syst Rev. 2009;(1):CD004754. doi: https://doi.org/10.1002/14651858.CD004754.pub2.
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