Scintigraphic screening for renal damage in siblings of children with symptomatic primary vesico-ureteric reflux

Objective To define prospectively the incidence of renal parenchymal lesion s in the siblings of patients treated at one institution for primary vesico -ureteric reflux (VUR). Patients and methods From January 1997 to October 1998, a prospective study including renal scintigraphy (using dimercaptosuccinic acid, DMSA) and a r adionuclide cystogram was proposed systematically to the asymptomatic sibli ngs of children treated for primary VUR. The radionuclide cystograms were i nterpreted as showing the presence or absence of VUR and the DMSA scan as s ymmetrical or asymmetrical differential function, with or with no renal def ect. Results Fifty-five families gave informed consent, of whom 46 completed the study (eight refused secondarily and one was omitted by exclusion criteria ), representing 46 symptomatic patients and 65 siblings. There were 17 sibl ings with VUR (26%) including two of 13 infants and 15 of 52 children aged >18 months. One radionuclide cystogram failed. Of the 17 refluxing siblings . four had a history of symptomatic urinary tract infection: 62 of the 65 s iblings had a DMSA scan, of which 56 were normal and six (10%) showed abnor malities (five asymmetrical differential function and one parenchymal defec t). Only one of these six patients had VUR at the time of the evaluation an d only one had a small kidney detected by ultrasonography on one side (and no VUR). There were no adverse effects associated with screening. Conclusion This study confirms a significant overall incidence of VUR (26%) in the asymptomatic siblings of patients treated for primary VUR. From the results of the DMSA scan (only one sibling had a parenchymal defect), the systematic screening of asymptomatic siblings does not appear to be benefic ial.