Risk factors for renal scarring and clinical morbidity in children with high-grade and low-grade primary vesicoureteral reflux

Aims: To determine the incidence of renal scarring among patients with primary vesicoureteral reflux (VUR) and the possible risk factor(s), we studied 69 children (42 girls and 27 boys) with VUR attending the Pediatric opd. Study Design: Prospective Observational study. Place and duration of Study: Department of pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Kashmir between June 2017 to June 2018. Methodology: All the patients were assessed for VUR grade by voiding cystoureterography and for presence of renal scarring by (99 m) technetium dimercapto–succinic acid scintigraphy. Results: Grade of reflux and number of urinary tract infection (UTI) episodes (≥3) were found to be statistically significant risk factors for renal scarring (P <0.05). However, there was no significant association with gender, familial history and laterality of the disease (P >0.05). Similarly, there was no statistically significant difference of frequency of renal scarring among the different age groups (P >0.05). Conclusions: It was concluded that recurrences of UTI and VUR severity are significant risk factors for renal scarring in children with VUR. Therefore, identification of VUR at an early age may offer the opportunity to prevent episodes of UTI and possible formation of renal scars that may result in end-stage renal failure.

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Risk factors for renal scarring in children with primary vesicoureteral reflux disease

Saudi Journal of Kidney Diseases and Transplantation ◽

10.4103/1319-2442.106241 ◽

2013 ◽

Vol 24 (1) ◽

pp. 54 ◽

Cited By ~ 5

Author(s):

Pelin Ertan ◽

Nese Ozkayin ◽

Sevgi Mir

Keyword(s):

Risk Factors ◽

Vesicoureteral Reflux ◽

Reflux Disease ◽

Renal Scarring ◽

Primary Vesicoureteral Reflux

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Primary Vesicoureteral Reflux in the Black Child

PEDIATRICS ◽

10.1542/peds.87.4.538 ◽

1991 ◽

Vol 87 (4) ◽

pp. 538-543

Author(s):

Steven J. Skoog ◽

A. Barry Belman

Keyword(s):

Vesicoureteral Reflux ◽

Renal Scarring ◽

Black Children ◽

Black Girls ◽

Spontaneous Resolution ◽

Time Interval ◽

Ureterovesical Junction ◽

Black Patients ◽

Primary Vesicoureteral Reflux ◽

White Patients

Primary vesicoureteral reflux is a polygenic abnormality due to a deficiency of the ureterovesical junction which allows urine in the bladder to ascend into the ureter and kidney. Fifty-one black children with primary vesicoureteral reflux were evaluated and treated at Children's Hospital from 1976 to 1986. The results of the evaluation and treatment were compared with those of 493 white patients with primary vesicoureteral reflux seen during the same time interval. The general approach to management was nonsurgical. There were no radical differences in the mode of presentation, age at presentation, and age at resolution. The distribution of reflux by maximum grade was not affected by race. Overall, 19 (37%) black children experienced spontaneous resolution of reflux. The mean duration of reflux in black children who had spontaneous resolution was 14.6 months. This duration was statistically significantly shorter than that in white patients with spontaneous resolution of vesicoureteral reflux (P < .005). Surgical correction was believed to be required in 8 (16%) patients and 8 (16%) were lost to follow-up. Renal scarring demonstrated by intravenous pyelogram or renal scan was initially present in 12 (23%) black patients compared with 65 (13%) white patients. This was due to a higher percentage of renal scarring in black girls which was not explained by distribution of grades of reflux. There was no progression of scarring in our black patients, whereas 3 (0.6%) white patients had progression of scarring. Although vesicoureteral reflux is rarely seen in black patients (9% of series), it has similar demographic features. Renal scarring is more frequent in black girls, but one can anticipate a faster rate of spontaneous resolution than in the white population.

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Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort

Diseases of the Esophagus ◽

10.1093/dote/doz061 ◽

2019 ◽

Cited By ~ 2

Author(s):

K Y Song ◽

A J Henn ◽

A A Gravely ◽

H Mesa ◽

S Sultan ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Barrett’S Esophagus ◽

Barrett's Esophagus ◽

Independent Risk Factor ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Increased Risk ◽

Low Grade Dysplasia

SUMMARY Patients with Barrett's esophagus (BE) and low-grade dysplasia (LGD) are at increased risk of esophageal adenocarcinoma (EAC), although many regress to nondysplastic BE. This has significant clinical importance for patients being considered for endoscopic eradication therapy. Our aim is to determine the risk for progression in patients with confirmed persistent LGD. We performed a single-center retrospective cohort study of patients with BE and confirmed LGD between 2006 and 2016. Confirmed LGD was defined as LGD diagnosed by consensus conference with an expert GI pathologist or review by an expert GI pathologist and persistence as LGD present on subsequent endoscopic biopsy. The primary outcome was the incidence rate of HGD (high-grade dysplasia)/EAC. Secondary outcomes included risk factors for dysplastic progression. Risk factors for progression were assessed using univariate and multivariate analysis with logistic regression. Of 69 patients (mean age 65.2 years) with confirmed LGD were included. In total, 16 of 69 patients (23.2%) with LGD developed HGD/EAC during a median follow-up of 3.74 years (IQR, 1.24–5.45). For persistent confirmed LGD, the rate was 6.44 (95% confidence interval (CI), 2.61–13.40) compared to 2.61 cases per 100 patient-years (95% CI, 0.83–6.30) for nonpersistent LGD. Persistent LGD was found in only 29% of patients. Persistent LGD was an independent risk factor for the development of HGD/EAC (OR 4.18; [95% CI, 1.03–17.1]). Persistent confirmed LGD, present in only 1/3 of patients, was an independent risk factor for the development of HGD/EAC. Persistence LGD may be useful in decision making regarding the management of BE.

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251 Post-coital bleeding and younger age are risk factors for high-grade dysplasia in women with biopsy proven low-grade squamous intraepithelial lesions

10.1136/ijgc-2019-igcs.251 ◽

2019 ◽

Author(s):

A Borovich ◽

D Nassie ◽

G Sabah ◽

G Cohen ◽

E Yehusa ◽

...

Keyword(s):

Risk Factors ◽

High Grade Dysplasia ◽

Low Grade ◽

High Grade ◽

Squamous Intraepithelial Lesions ◽

Younger Age ◽

Intraepithelial Lesions

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Biomarkers in vesicoureteral reflux: an overview

Biomarkers in Medicine ◽

10.2217/bmm-2019-0378 ◽

2020 ◽

Vol 14 (8) ◽

pp. 683-696

Author(s):

Flávia C Valério ◽

Renata D Lemos ◽

Ana L de C Reis ◽

Letícia P Pimenta ◽

Érica LM Vieira ◽

...

Keyword(s):

Vesicoureteral Reflux ◽

Renal Scarring ◽

Reflux Nephropathy ◽

Serum Levels ◽

Cellular Adhesion ◽

High Grade ◽

Epigenetic Factors ◽

Cellular Adhesion Molecules ◽

Potential Biomarkers

Aim: This article aimed to review the role of cytokines, chemokines, growth factors and cellular adhesion molecules as biomarkers for vesicoureteral reflux (VUR) and reflux nephropathy (RN). Methods: We reviewed articles from 1979 onward by searching PubMed and Scopus utilizing the combination of words: ‘VUR’ or ‘RN’ and each one of the biomarkers. Results: Genetic, inflammatory, fibrogenic, environmental and epigenetic factors responsible for renal scarring need to be better understood. TGF-β, IL-10, IL-6, IL-8 and TNF seem to exert a role in VUR particularly in RN based on the current literature. Serum levels of procalcitonin have been also associated with high-grade VUR and RN. These molecules should be more intensively evaluated as potential biomarkers for renal scarring in VUR. Conclusion: Further studies are necessary to define which molecules will really be of utility in clinical decisions and as therapeutic targets for VUR and RN.

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Secondary brain tumors in children treated for acute lymphoblastic leukemia at St Jude Children's Research Hospital.

Journal of Clinical Oncology ◽

10.1200/jco.1998.16.12.3761 ◽

1998 ◽

Vol 16 (12) ◽

pp. 3761-3767 ◽

Cited By ~ 187

Author(s):

A W Walter ◽

M L Hancock ◽

C H Pui ◽

M M Hudson ◽

J S Ochs ◽

...

Keyword(s):

Risk Factors ◽

Acute Lymphoblastic Leukemia ◽

Brain Tumors ◽

Lymphoblastic Leukemia ◽

Low Grade ◽

High Grade ◽

Research Hospital ◽

Dose Dependent

PURPOSE To evaluate the incidence of and potential risk factors for second malignant neoplasms of the brain following treatment for childhood acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS The study population consisted of 1,612 consecutively enrolled protocol patients treated on sequential institutional protocols for newly diagnosed ALL at St Jude Children's Research Hospital (SJCRH) between 1967 and 1988. The median follow-up duration is 15.9 years (range, 5.5 to 29.9 y). RESULTS The cumulative incidence of brain tumors at 20 years is 1.39% (95% confidence interval [CI], 0.63% to 2.15%). Twenty-two brain tumors (10 high-grade gliomas, one low-grade glioma, and 11 meningiomas) were diagnosed among 21 patients after a median latency of 12.6 years (high-grade gliomas, 9.1 years; meningiomas, 19 years). Tumor type was linked to outcome, with patients who developed high-grade tumors doing poorly and those who developed low-grade tumors doing well. Risk factors for developing any secondary brain tumor included the presence of CNS leukemia at diagnosis, treatment on Total X therapy, and the use of cranial irradiation, which was dose-dependent. Age less than 6 years was associated with an increased risk of developing a high-grade glioma. CONCLUSION This single-institution study, with a high rate of long-term data capture, demonstrated that brain tumors are a rare, late complication of therapy for ALL. We report many more low-grade tumors than others probably because of exhaustive long-term follow-up evaluation. The importance of limiting cranial radiation is underscored by the dose-dependent tumorigenic effect of radiation therapy seen in this study.

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