URINARY-TRACT INFECTION AND RENAL DAMAGE IN SIBLING VESICOURETERAL REFLUX

Purpose: Siblings of index patients with vesicoureteral reflux are kno wn to have an increased incidence of reflux. Previously reported studi es have evaluated vesicoureteral reflux in asymptomatic siblings of ch ildren who were previously proved to have reflux. We determine the inc idence and nature of vesicoureteral reflux in symptomatic siblings of children with documented vesicoureteral reflux. Materials and Methods: Between January 1990 and December 1996, 624 patients were diagnosed w ith vesicoureteral reflux during the investigation of documented urina ry tract infections. All patients were evaluated for reflux by contras t voiding cystourethrography and reflux was graded according to the in ternational reflux study. (99m)Technetium dimercapto-succinic acid nuc lear renal scans were performed to detect renal scarring. The medical records and voiding cystourethrograms of the 624 consecutive patients with vesicoureteral reflux were retrospectively reviewed to identify s iblings with vesicoureteral reflux. Results: Vesicoureteral reflux was noted in 85 siblings (134 refluxing ureters) of the 624 index patient s (13.6%), including 1 and 2 siblings of 38 and 3 patients, respective ly. Mean age at presentation of the 37 boys and 48 girls was 2.5 years . Reflux was unilateral in 36 siblings and bilateral in 49. Reflux was grades I to V in 8, 9, 51, 55 and 11 meters, respectively. Nuclear sc an revealed reflux nephropathy in 22 of the 77 tested siblings (28.5%) . Conclusions: When vesicoureteral reflux is discovered in symptomatic siblings, it is usually high grade and associated with a higher incid ence of reflux nephropathy. Of further interest are the findings that refluxing symptomatic siblings of index patients are usually younger a nd boys are as commonly affected as girls. Screening for vesicouretera l reflux in asymptomatic siblings is recommended to decrease the incid ence of reflux nephropathy.