Recent research by David Hains, MD, MBA, Michelle C. Starr, MD, MPH and Andrew L. Schwaderer, MD, physician-scientists and pediatric nephrologists at Riley Children’s Health, explores new findings around kidney damage in children with vesicoureteral reflux (VUR).
Their study, published in JAMA Pediatrics, suggests children with VUR are prone to developing a urinary tract infection (UTI), which can greatly affect the kidney. As a result, the research team heads a clinical trial to suggest improvements for VUR management in children.
VUR is a common congenital condition where the urine flows abnormally from the bladder to the kidney. Common in infants and children, VUR can increase the risk of contracting UTI, causing illness and potential long-term damage to the kidney. Aiming to find a better treatment approach for this diagnosis, the study, named The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) trial, tested a pool of 200 children with VUR and UTIs and evaluated the antibiotic prophylaxis as a potential treatment solution. The primary goal was to determine whether these infections are associated with notable declines in kidney function.
"For the past few decades, a clinical debate has existed amongst pediatricians, pediatric urologists, pediatric nephrologists, and other subspecialists on the best way to handle a child with VUR,” Dr. Hains said, who is the division chief of pediatric nephrology at Riley Children’s. “We can observe kids and wait for them to grow out of it, but a small subset of those kids will have UTIs and maybe kidney damage."
By the end of the research, the results were striking, showing children with VUR and a UTI had a noticeable decrease in glomerular filtration rate (eGFR), a key measure of kidney health, indicating a decline in kidney function. These results conclude that using preventative antibiotics, like prophylaxis, might reduce the severity of VUR and UTIs, thus protecting kidney health in the long-term.
“We have found that kids with VUR and UTIs have more genetic variations in these urinary tract protection genes, and thus a possible source of some of their UTIs,” Dr. Hains added. "In this study, one thing we found was that kidney function changes did not correlate to dimercaptosuccinic acid (DMSA) scan findings, suggesting that perhaps we are using the wrong test to study this issue.”
Overall, research proves there are important implications to consider when managing pediatric patients with VUR. Moving forward, the research team plans to take this study to a larger cohort of patients in the future to not only to protect the longevity of pediatric kidneys, but to also positively impact the future of pediatric nephrology.
“Medicine has changed dramatically over the past few decades, so using technology from the 1980s or earlier—or assuming that the ‘gold standard’ from that era still applies—may need to be reconsidered," Dr. Hains said.