Vesicoureteral Reflex, Renal Scarring, and Slowed Growth
ABSTRACT & COMMENTARY
Synopsis: Children with urinary tract infections, bilateral vesicoureteral reflux and renal scarring have decreased height and weight as reflected by height standard deviation score and weight-for-height index.
Source: Polito C, et al. Height and weight in children with vesicoureteric reflux and renal scarring. Pediatr Nephrol 1996;10:564-567.
Polito and colleagues from naples, italy, studied 156 children with urinary tract infection and vesicoureteral reflux (VUR) seen at their institution over a six-year period. All had at least Grade 2 VUR (i.e., reflex into the renal pelvis) and were evaluated for the presence of scarring by DMSA renal scanning. Of the 156, 117 were girls, and the mean age was 3.7 years (range, 2 months-10.8 years). All had normal renal function as reflected by estimated creatinine clearances greater than 80 mL/min/1.73M2.
Patient heights were expressed in terms of standard deviation for ages and weights expressed as weight-for-height index (weight/median weight for height age ´ 100). Children were grouped according to whether reflux was unilateral or bilateral and to whether scarring was present. When compared to an age-matched health control group, differences existed only in the group with bilateral reflux and scarring. There were 43 children in this group, and although the differences for height and weight reached statistical significance vs. controls, they were not different than standard normals for age. The authors speculate that the renal concentrating defect frequently associated with scarring and VUR may interfere with normal growth.
COMMENT BY THOMAS KENNEDY, MD, FAAP
We are well aware of the common association of VUR (35-40%) in young children with febrile and presumed parenchymal urinary tract infection and the significant risk of scar formation (25-30%), especially in very young children and those with intrarenal reflux. When a child with scarring is identified, we generally focus on monitoring renal function and blood pressure. Now, it appears that we must closely assess growth as well. There is no need to reach for growth hormone, since the decreased height and weight parameters measured for the at-risk group are modest. The determinations in this study are at one time only, however, and longitudinal follow-up may identify individuals with VUR and renal scars whose growth is significantly delayed over a period of years.
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