27. The Time Factor in the Development of Sterile Renal Scarring following High-Pressure Vesicoureteral Reflux

More than 40 papers were read before the Urology Section of the annual meeting of the American Academy of Pediatrics in Chicago, October 17 to 2i, 1976. Some of those papers were presented as parts of symposia currently important to both pediatricians and urologists. Three such symposia are summarized in this report. EFFECT OF VESICOURETERAL REFLUX ON THE KIDNEY Vesicoureteral reflux continues to be a controversial topic and one in which the parameters for management are being constantly reassessed. The Joint Action Committee on Vesicoureteral Reflux presented a panel discussion emphasizing the effects of reflux on the kidney. The most fundamental facts about reflux concern its relationship to bacteriuria and chronic renal scarring.1 While prevalence of bacteriuria in preschool girls is about 1%, in school-age girls it rises to about 2%. In these children the emergence rate of urinary tract infection is between 3% and 5%. Among girls found to have bacteriuria the prevalence of reflux is 20% to 30% with renal scarring being present in 15% to 20% of this group. These latter figures are considered to be conservative estimates. Actually, 90% of children with renal scarring demonstrate evidence of current or previous vesicoureteral reflux.2 The data of Winberg et al. indicate that the kidney is most vulnerable to scarring during the first year of life.3 In 1969 Hodson introduced the concept that intrarenal reflux may be the primary factor leading to renal scarring. In support of his concept Hodson et al. carried out extensive experimental studies in swine, an animal selected because of the similarities between the kidney of the pig and that of the humans.4

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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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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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