Independent risk factors for renal damage in a series of primary vesicoureteral reflux: A multivariate analysis
Article first published online: 31 MAR 2009
© 2009 The Authors. Journal compilation © 2009 Asian Pacific Society of Nephrology
Volume 14, Issue 2, pages 198–204, March 2009
How to Cite
SILVA, J. M. P., DINIZ, J. S. S., LIMA, E. M., PINHEIRO, S. V., MARINO, V. P., CARDOSO, L. S. B., COLOSIMO, E. A., SILVA, A. C. S. E. and OLIVEIRA, E. A. (2009), Independent risk factors for renal damage in a series of primary vesicoureteral reflux: A multivariate analysis. Nephrology, 14: 198–204. doi: 10.1111/j.1440-1797.2008.01046.x
- Issue published online: 31 MAR 2009
- Article first published online: 31 MAR 2009
- Accepted for publication 11 August 2008.
- foetal hydronephrosis;
- reflux nephropathy;
- renal scarring;
- urinary tract infection (UTI);
- vesicoureteral reflux
Aim: The aim of this study was to investigate risk factors associated with different extents of renal parenchyma involvement in a paediatric series of primary vesicoureteral reflux (VUR).
Methods: A total of 549 patients with VUR were analyzed. The variable of interest was renal scar, assessed by technetium-99m dimercaptosuccinic acid scan, and classified into three subtypes: focal scar, multiple cortical scarring and diffuse scars with a contracted renal unit. The multinomial regression model was applied to identify independent variables associated with each subtype of renal damage.
Results: After adjustment, four variables remained independently associated with a contracted renal unit: reflux grades III–V (odds ratio (OR) = 9.7; 95% confidence interval (CI) = 4.1–21.0), age at diagnosis (OR = 3; 95% CI = 1.6–5.1), unilateral reflux (OR = 2.1; 95% CI = 1.2–3.8), and male sex (OR = 2; 95% CI = 1.1–3.8). Two variables were associated with multiple scars: reflux grades III–V (OR = 13.8; 95% CI = 7.4–26.0) and age at diagnosis (OR = 1.9; 95% CI = 1.2–3.0). Two variables were associated with a focal scar: reflux grades III–V (OR = 7.9, 95% CI CI = 3.8–16.4) and male sex as a protective factor (OR = 0.5; 95% CI = 0.25–1.0).
Conclusion: Our findings suggest that the development of a contracted renal unit is probably due to congenital malformation, more commonly observed in male infants with high-grade reflux.