Reuters Health Information (2014-03-31): Renal functional abnormalities common in siblings of patients with vesicoureteral reflux

Epidemiology

Renal functional abnormalities common in siblings of patients with vesicoureteral reflux

Last Updated: 2014-03-31 12:44:59 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Renal cortical abnormalities are common in siblings of patients with vesicoureteral reflux (VUR), researchers from Ireland have found.

VUR is known to run in families, and siblings of children with VUR have a much higher risk for reflux than the general pediatric population, they write in Pediatrics, online March 24. But whether this translates into higher rates of renal damage remains unclear.

"When VUR was discovered in siblings less than 3 years of age, whether symptomatic or asymptomatic, it was usually high-grade VUR," said senior author Dr. Prem Puri from National Children's Research Centre at Our Lady's Children's Hospital in Dublin.

"We found that the incidence of renal scarring in symptomatic siblings was identical to that of index patients and significantly higher than in asymptomatic siblings," he told Reuters Health by email. "We therefore recommend screening all children under the age of the 3 years for VUR."

Dr. Puri and colleagues analyzed data from 275 families with VUR to assess the prevalence in siblings and the risk factors associated with renal functional abnormalities in the siblings with VUR.

Among 424 siblings screened, 190 (45%) were found to have VUR. Another 128 siblings were diagnosed with VUR after a urinary tract infection.

More than half the siblings with VUR (55%) were less than one year old, and the rest were between one and six. VUR in siblings was high-grade in 46%.

Renal functional abnormalities were more common in index patients (37%) than in siblings (23%). They were more commonly found in siblings diagnosed with VUR after urinary tract infection (34%) than in siblings diagnosed with VUR after screening (15%).

On multivariate analysis, previous urinary tract infection, high-grade reflux, and age under one year were the most significant independent risk factors associated with renal functional abnormalities in siblings of patients with VUR.

"Screening siblings of index patients with VUR should allow us to detect the population of risk, potentially allowing us to prevent adverse outcomes associated with VUR such as urinary tract infections, pyelonephritis, and renal scarring," Dr. Puri said.

"We recommend that the families should be informed about the increased likelihood of another sibling having VUR," Dr. Puri concluded. "Furthermore, the long-term concerns of hypertension and renal functional loss should be outlined when counseling parents about the risk of familial VUR."

SOURCE: http://bit.ly/1hZKtay

Pediatrics 2014.