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Recent years has seen an increasing interest in the quality of life (QOL) of children with chronic kidney disease (CKD). The objective of this cross-sectional study was to investigate the prevalence of behavioral disorders and to assess the health-related QOL (HRQOL) in 136 patients with CKD. To estimate the prevalence of behavior disorders and analyze HRQOL, we used the Strengths and Difficulties Questionnaire (SDQ) and Pediatric Inventory of Quality of Life (PedsQL) Core Scales as assessment tools for both the patients and caregivers. When compared to healthy controls, the CKD group had significantly lower scores in almost all PedsQL domains. After adjustment, only absence of religion/other religions remained significantly associated with a lower global HRQOL score [odds ratio (OR) 6.2, P=0.009]. Among the parents, two factors remained significantly associated with a lower global HRQOL score: patients' age >10 years (OR 5.4, P=0.033) and absence of religion/other religions (OR 3.2, P=0.038). The CKD group demonstrated a higher proportion of behavioral and emotional disorders in all SDQ domains. There was a negative correlation between the presence of behavior and emotional disorders and HRQOL score (r= -0.552, P<0.001). Our findings suggest the importance of evaluating behavioral and social repercussions of CKD in order to improve the life quality of this pediatric population.

Purpose: The aim of this study was to evaluate the diagnostic accuracy of dimercapto-succinic acid renal scintigraphy and renal ultrasound in identifying high grade vesicoureteral reflux in children after a first episode of urinary tract infection., Materials and Methods: A total of 533 children following a first urinary tract infection were included in the analysis. Patients were assessed by 3 diagnostic imaging studies, renal ultrasound, dimercapto-succinic acid scan and voiding cystourethrography. The main event of interest was the presence of high grade (III to V) vesicoureteral reflux. The combined and separate diagnostic accuracy of screening methods was assessed by calculation of diagnostic OR, sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratio., Results: A total of 246 patients had reflux, of whom 144 (27%) had high grade (III to V) disease. Sensitivity, negative predictive value and diagnostic OR of ultrasound for high grade reflux were 83.3%, 90.8% and 7.9, respectively. Dimercapto-succinic acid scan had the same sensitivity as ultrasound but a higher negative predictive value (91.7%) and diagnostic OR (10.9). If both tests were analyzed in parallel by using the OR rule, ie a negative diagnosis was established only when both test results were normal, sensitivity increased to 97%, negative predictive value to 97% and diagnostic OR to 25.3. Only 9 children (6.3%) with dilating reflux had an absence of alterations in both tests., Conclusions: Our findings support the idea that ultrasound and dimercapto-succinic acid scan used in combination are reliable predictors of dilating vesicoureteral reflux., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Knowledge of risk of urinary tract infection (UTI) recurrence in vesicoureteral reflux (VUR) can help clinicians make therapeutic decisions. The aim of this retrospective cohort study was to identify risk factors associated with recurrent urinary tract infection in children with VUR. In addition, a risk score that might predict the chance of UTI recurrence was also proposed., Methods: Between 1970 and 2007, 740 patients were diagnosed with VUR and were systematically followed up at a single tertiary Renal Unit. Recurrent UTI was defined as more than 1 episode during follow-up. A binary logistic regression model was applied to identify variables independently associated with recurrent UTIs., Results: During follow-up, information was obtained on 58,856 person-months. Recurrent UTIs occurred in 120 (16.2%) patients. The overall incidence rate of UTI was 8.4 episodes per 1000 person-months (95% CI, 7.7, 9.2). After adjustment by multivariable analysis, 5 variables were independent predictors of recurrent UTI: UTI as clinical presentation, age < 6 months, female gender, dysfunctional elimination syndrome, and severe grade of reflux. The risk for recurrent UTI was classified as low in 24% of children, medium in 42%, and high in 34%. UTI incidence rates per 1000 person-months were 4.3 (95% CI, 3.2, 5.6), 7.9 (95% CI, 6.7, 9.1), and 11.3 (95% CI, 9.9, 12.8) for low-, medium-, and high-risk groups, respectively., Conclusion: The prediction model of recurrent UTI allows an early recognition of patients at risk for long-term morbidity and might contribute to the formulation of therapeutic strategies.

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.

The aim of this report was to estimate the risk of hypertension in children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR at a single tertiary renal unit. Of 735 patients, 664 (90%) were systematically followed and had multiple measurements of blood pressure. Hypertension was defined as values persistently above 95th for age, sex, and height in three consecutive visits. Risk of hypertension was analyzed by the Kaplan-Meier method. Of 664 patients followed, 20 (3%) developed hypertension. The estimated probability of hypertension was 2% (95%CI, 0.5%-3%), 6% (95%CI, 2%-10%), 15% (95%CI, 11%-20%) at 10, 15, and 21 years of age, respectively. The prevalence of hypertension has increased with age: it was 1.7% for patients with 1 yr-9.9 yr, 1.8% for adolescents with 10 yr-14.9 yr, 4.7% for patients with 15-19.9 yr, and 35% for patients>20 years at the end of the follow-up (P<0.001). It was estimated by survival analysis that 50% of patients with unilateral and bilateral renal damage would have sustained hypertension at about 30 and 22 years of age, respectively. Hypertension increased with age and was strongly associated with renal damage at entry in an unselected population of primary VUR.

Objectives: To evaluate the sonographic involution of prenatally detected multicystic dysplastic kidney (MCDK)., Methods: A total of 53 children with unilateral MCDK detected by prenatal ultrasonography between 1989 and 2004 were included in this analysis. All children received conservative management with follow-up visits every 6 months. Follow-up ultrasound examinations were performed at 6-month intervals during the first 2 years after birth and yearly thereafter. A linear mixed effect model was constructed, including MCDK length as the dependent variable and body size parameters and contralateral renal dimensions as independent variables., Results: The mean follow-up time was 68 months. A total of 334 ultrasound scans were analyzed. The ultrasound scan demonstrated partial or total involution of the MCDK in 48 cases (91%). A consistent negative correlation was found among MCDK length, patient age, and body size parameters. As a whole, the MCDK length reduction was estimated to be 0.29 mm/mo. The rate of reduction was not constant over time and was intense during the first 30 months of age. According to the regression model, MCKD reduced in length by 0.80 mm/mo during the first 30 months of age, 0.26 mm between 30 and 84 months old, and 0.30 mm in children older than 84 months., Conclusions: Our results suggest a clear tendency of MCDK to decrease in size, with the rate of the involution greater during the first 30 months than the rate in older children.

Objective: To identify independent factors predicting the resolution of primary vesico-ureteric reflux (VUR) in a cohort of medically managed children., Patients and Methods: Between 1977 and 2003, 506 children were diagnosed with VUR and were conservatively managed and prospectively followed. All of the children were maintained on antibiotic prophylaxis. Follow-up imaging consisted of voiding cysto-urethrography (VCUG) or a direct isotope cystogram at intervals of 2-3 years. The predictive factors used are based on the patient data at the time of entry in the protocol. The dependent variable was VUR resolution. The criterion for resolution was based on a single negative VCUG or direct isotope cystogram. A survival analysis identified variables significantly associated with VUR resolution. Cox's regression model was applied to identify variables independently associated with the dependent variable., Results: After adjustment, four variables remained as independent predictors of VUR resolution: nonwhite race, relative risk (95% confidence interval) of 1.5 (1.1-1.9; P = 0.009); mild grade of VUR, 3.3 (2.1-5.3; P < 0.001); absence of renal damage, 3.3 (2.4-4.5; P < 0.001); and absence of dysfunctional voiding, 2.0 (1.4-3.1; P < 0.001). For mild VUR, three variables were significantly associated: male gender, 1.7 (1.1-2.6; P = 0.012); absence of renal damage, 3.4 (1.8-6.4; P < 0.001); and unilateral VUR, 1.6 (1.1-2.3; P = 0.004). For moderate/severe VUR, three variables were significantly associated: nonwhite race, 1.7 (1.1-2.6; P = 0.01); absence of renal damage, 3.0 (2.0-4.4; P < 0.001); and absence of dysfunctional voiding, 2.8 (1.4-5.5; P = 0.004)., Conclusion: Few factors are amenable to intervention to modify the natural history of VUR. According to our findings, there are only two possible interventions: avoiding renal scars and managing voiding dysfunction.

The purpose of this retrospective cohort study was to report the clinical course of children and adolescents with primary focal segmental glomerulosclerosis (FSGS). The records of 110 patients with biopsy-proven FSGS admitted between 1972 and 2004 were retrospectively reviewed. Demographic, clinical and laboratory data were recorded and histopathological data were reanalyzed by one pathologist who had no information about the outcome of the patients. Renal survival analysis was performed using the Kaplan-Meier method. Differences between subgroups (response to corticosteroids) were assessed by the two-sided log rank test. The median age at admission was 5 years (range: 1-15 years). Forty-two patients (38.2%) presented with hematuria at admission, and 55 (50%) presented blood pressure levels above the 95th percentile. Mean follow-up time was 10 years (SD 5.5). Twenty-four patients (21.8%) presented chronic kidney disease (CKD). It was estimated that the probability of CKD was 8% at 5 years, 17% at 10 years, and 32% at 15 years after diagnosis of nephrotic syndrome. In conclusion, on the basis of the clinical and histological characteristics observed, apparently our cohort of idiopathic FSGS is comparable with other published series. However, the long-term overall renal survival seems to be better in our cohort.