Renal scarring in familial vesicoureteral reflux: Is prevention possible?

Purpose: Detailed knowledge about risk factors for renal scarring in familial reflux is necessary to decide whether these factors could be influenced by early screening and treatment of siblings. We evaluated the prevalence of and risk factors influencing renal scarring in familial vesicoureteral reflux. Materials and Methods: We reviewed the medical records and dimercapto-succinic acid scans of 306 children with familial vesicoureteral. reflux. Scarring was classified as mild, moderate and severe. The impact of urinary tract infections, patient sex, reflux grade and age at diagnosis on renal scarring was evaluated. Results: The prevalence of renal scarring was identical at 36% in 142 index patients and 74 siblings presenting with urinary tract infection but it was only 10% in 87 asymptomatic siblings (p < 0.001) The difference between siblings with and without urinary tract infection was only statistically significant for mild scarring (23% vs 4.6%, p < 0.001). It did not attain significance in those with moderate to severe scarring (13.5% vs 5.7%). Moderate to severe scarring was significantly more common in grade V than in grade IV refluxing units (43% vs 10%, p < 0.0001) and in male than in female siblings (15.8% vs 3.4%, p = 0.012). Mild scarring was not significantly associated with reflux grade or patient sex. Children diagnosed before age 3 years showed significantly less scarring than patients diagnosed later (23% vs 41%, p < 0.002). Conclusions: The development of mild renal scarring seems to mainly depend on urinary tract infections, while moderate and severe scarring are also associated with high grade reflux and male sex. Early detection and treatment may prevent further urinary tract infections as well as reflux related kidney damage.