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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
ORIGINAL ARTICLE  
Year : 2011  |  Volume : 22  |  Issue : 4  |  Page : 723-726
Growth indices in urinary tract infection children with or without vesicoureteral reflux


1 Pediatric Nephrology Department, Tabriz Medical University, Tabriz Children Hospital, Tabriz, Iran
2 Pediatric Nephrology Department, Kermanshah Medical University, Imam Reza Hospital, Kermanshah, Iran

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Date of Web Publication9-Jul-2011
 

   Abstract 

To determine the growth quality in children, less than 5 years of age, affected with urinary tract infection (UTI) and to compare the indices between patients with and without vesico-ureteral reflux (VUR) based on their reflux severity and/or laterality, we studied 106 children less than 5 years of age with UTI at Imam Reza Hospital of Kermanshah, Iran, and divided the study group into four subgroups based on their cystouretrography results as follows: Group 0: without reflux (as control group); Group 1: mild VUR; Group 2: moderate VUR; and Group 3: severe VUR. In all the subgroups, weight height index (WHI) was lower than 100% and was 96%, 93%, 95%, and 98%, respectively. We found no correlation between reflux severity and WHI in all the subgroups. In addition, the difference in the mean height standard deviation score (HSDS) (0.10, -0.12, -0.19, and -0.22, respectively) in the different subgroups was statistically insignificant. The mean WHI in the group with unilateral and bilateral reflux was 94.5% ± 8.9% and 95.0% ± 8.16%, respectively, while the mean HSDS was -0.16 ± 0.35 and -0.18 ± 0.38, respectively, and the difference was statistically insignificant in both the cases. We conclude that in children with UTI and normal glomerular filtration rate, the existence of reflux with all grades of severity and laterality exerts no impact on the growth index.

How to cite this article:
Malaki M, Sayedzadeh SA, Shoaran M. Growth indices in urinary tract infection children with or without vesicoureteral reflux. Saudi J Kidney Dis Transpl 2011;22:723-6

How to cite this URL:
Malaki M, Sayedzadeh SA, Shoaran M. Growth indices in urinary tract infection children with or without vesicoureteral reflux. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2019 Jul 15];22:723-6. Available from: http://www.sjkdt.org/text.asp?2011/22/4/723/82654

   Introduction Top


Vesicoureteral reflux (VUR) is a common urological abnormality in children, especially those who are affected by urinary tract infection, with a prevalence of 35-45%. [1],[2],[3] Such patients are prone to acute pyelonephritis associated with scarring and ultimately chronic pyelonephritis. Severe reflux nephropathy and multiple scars gradually cause hypertension proteinuria and decreased renal function. [4],[5] The International Reflux Studying Group classified the reflux severity into five groups by contrast radiological imaging, from only ureter filling by contrast to renal pelvic filled without dilatation (mild), to mild pelvic dilatation (moderate), to moderate and severe pelvic dilatation (severe). [6]

Urinary tract infection (UTI) can cause growth failure, and studies conducted in the last two decades have aimed at the growth indices in VUR as a main cause of complicated UTI. [7],[8]

We aim in our study to determine the growth quality in children, under 5 years of age, affected with UTI and to compare the indices between patients with and without VUR based on their reflux severity and/or laterality.


   Patients and Methods Top


Children under 5 years of age were investigated for febrile UTI at Kermanshah Imam Reza hospital and classified according to their VUR. We evaluated their glomerular filtration rate (GFR) adjusted for their age and defined low GFR as less than 80 mL/1.73 m 2 /min. In addition, we measured weight in upright position for children over 2 years and in recumbent position with digitalized infantile scale for those under 2 years. We also measured height in the upright position for children over 2 years and in recumbent position for children of age under 2 years. Their age in months, weight in grams and height in centimeters were recorded. Weight to height ratios were depicted on specified growth charts from birth to 36 months for all patients besides the weight for stature percentile charts. We considered the weight to height ratio of less than 80% to denote a lean body and above 120% to denote obesity. Height standard deviation score (HSDS) below -2 was considered as short height and above +2 as appropriate height.

*weight for height index (WHI) = weight/median weight for the height age × 100

**HSDS = (child height -mean height for age)/SD for height at that age


   Statistical Analysis Top


Data were analyzed using a statistical package for social science (SPSS 11) software. Data were presented as mean ± standard deviation. Categorical data were analyzed by chi-square test, and for quantitative data, analysis of variance (ANOVA) test was used; for comparison of WHI and HSDS between groups, we used one-way ANOVA (the power 95% for comparison and basis of previous study sample size was 29 for controls and patients with mild to moderate VUR, while the power 90% of sample size for severe group was 19). P less than 0.05 was considered statistically significant.


   Results Top


We studied a total of 106 children with age ranging from one to 60 months (mean ± SD 17.46 ± 13.86 months). We divided the study group into four subgroups based on their cystouretrography results as follows: Group 0: without reflux (as control group); Group 1: mild VUR; Group 2: moderate VUR; and Group 3: severe VUR. Distribution of age and sex between groups is summarized in [Table 1].
Table 1: Age and gender in the different vesicoureteral reflux (VUR) groups.

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There was not any correlation between age and reflux severity. Increase in severity of reflux was associated with high female to male proportion.

There were 36 cases with unilateral reflux and 41 patients with bilateral reflux. Bilaterality was detected in 48% of mild, 62% of moderate, and 50% of severe reflux patients. However, there was no correlation between reflux severity and laterality of reflux [Table 2].
Table 2: Growth indices and laterality in different groups of vesicoureteral reflux (VUR) severity.

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HSDS was measured in all the subgroups and compared to each other. The mean of HSDS in the control group was -0.10 and had a decreasing order of -0.12, -0.19, -0.22 in mild moderate and severe subgroups, respectively. However, there was no correlation between the presence of reflux or its severity and HSDS.

Sixty-five percent of children in the control group, 62% in the mild VUR group, 72% in the moderate VUR group, and 70% in the severe VUR group had HSDS below 0.00 [Table 3] and [Figure 1].
Figure 1: Vesicoureteral reflux (VUR) severity and height standard deviation score (HSDS).

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Table 3: Growth indices and vesicoureteral reflux (VUR) severity.

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With regard to the weight loss identified by WHI that shows how lean the children were, the patients in the control subgroup had an index of 96.1%, and in the subgroups of mild, moderate and severe VUR, the patients had an index of 93.2%, 95.5% and 98.5%, respectively. There was not any correlation between having reflux or its severity and the WHI ([Table 3] and [Figure 2]).
Figure 2: Weight height index (WHI) in different vesicoureteral reflux (VUR) groups.

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The mean WHI in the patients with unilateral reflux was 94.5 ± 8.9 and in those with bilateral VUR was 95.0 ± 8.16. In addition, the mean HSDS in the patients with unilateral VUR was -0.16 ± 0.35 and in those with bilateral VUR was -0.18 ± 0.38; however, the difference was statistically insignificant.


   Discussion Top


Our results did not show any correlation between physical growth and severity or laterality of the VUR. The mean indices of growth disclosed no differences in the children below five years of age.

The relationship between VUR and physical growth was addressed by previous studies that focused on the effects of prophylactic antibiotics on growth, and other studies which tried to find that VUR had no adverse effect on growth and also tried to find the role of reflux laterality on growth. In a study on 306 children under 11 years with moderate and severe VUR, receiving medical and surgical treatment and followed for 10 years, the severity of VUR, scarring after infection, and surgical or medical treatment had no effect on the growth of children. [9] Furthermore, in another study on 85 children with UTI stratified to those with and without VUR, it was found that patients' age, severity, or laterality of VUR with normal GFR had no effect on growth. [10] Another study gave similar conclusions. [11]

On the other hand, in a case report, two infants with failure to thrive (FTT) were worked up for their growth problem and were found to have pseudohypoaldosteronism following UTI and VUR. Authors suggested VUR as a cause of FTT. [12] In another study on 156 children divided into bilateral or unilateral VUR with and without scarring, it was found that patients with bilateral reflux with scarring had a significant growth retardation. [13]

The use of antibiotic prophylaxis for the VUR patients for 2 years had no effect on growth improvement. [14] However, other studies found positive effects of long-term prophylaxis on growth improvement in children regardless of the severity and laterality of the reflux or scarring. [15],[16],[17]

We conclude that our study on children under 5 years of age with UTI and normal GFR and not on long-term antibiotic prophylaxis found no differences in physical growth indices related to grades or laterality of VUR.

 
   References Top

1.Dillon MJ, Goonasekera CD. Reflux nephropathy. J Am Soc Nephrol 1998;9:2377-80.  Back to cited text no. 1
[PUBMED]  [FULLTEXT]  
2.Shah KJ, Robbins DG, White RHR. Renal scarring and vesicoureteric reflux. Arch Dis Child 1978;53:210-15.  Back to cited text no. 2
    
3.Smellie JM, Normand IC, Katz G. Children with urinary infection: Comparison of those with and without vesicoureteric reflux. Kidney Int 1981; 20:717-9.  Back to cited text no. 3
[PUBMED]    
4.Bailey RR. The relationship of vesico-ureteric reflux to urinary tract infection and chronic pyelonephritis-reflux nephropathy. Clin Nephrol 1973;1:132-5.  Back to cited text no. 4
[PUBMED]    
5.El-Khatib M, Packham DK, Becker GJ, Kincaid-Smith P. Pregnancy related complications in women with reflux nephropathy. Clin Nephrol 1994;41:50-6.  Back to cited text no. 5
[PUBMED]    
6.Smelli JM, Parrat TM. Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee. Pediatrics 1981;67:392-4.  Back to cited text no. 6
    
7.Sutton R, Atwell JD. Physical growth after succesful antireflux surgery. J Urol 1979;122: 253-5.  Back to cited text no. 7
    
8.Caione P, Ciofetta G, Collura G. Renal damage in vesico-ureteric reflux. BJU Int 2004;93:591-4.  Back to cited text no. 8
    
9.Wingen AM, Koskimies O, Olbing H, Sepannen J, Tamminenmobious T. Growth and weight gain in children with VUR, Receiving medical versus surgical treatment. Acta Pediatr 1999;88(1):56-61.  Back to cited text no. 9
    
10.Baquedano Droquett P, Triyino Bonifay X, Bedregal Garcia P. Weight Stature Growth in Urinary tract infection with or without reflux. Atena Primaria 2000;30;26;298-301.  Back to cited text no. 10
    
11.Hoyer PF, Lax H, Smelli JM, Jodal U. Ten years results of randomized treatment of children with severe vesicoureteral reflux. Pediatr Nephrol 2006;21:785-92.  Back to cited text no. 11
    
12.Klingenberg C, Hagen IJ. Transient Pseudo-hypoaldosteronusm in infants with vesicoureteral reflux. Tidsskr Nor Laegeforen 2006;26(126): 315-7.  Back to cited text no. 12
    
13.Polito C, La Manna A, Cappacchinoe A, Pullans F. Height and Weight in children with vesico-ureteral reflux and renal scarring. Pediatr Nephrol 1996;10;564-7.  Back to cited text no. 13
    
14.Marrel RW, Mowal JJ. Increase physical growth after successful antireflux operation. J Uro 1979; 122;523-7.  Back to cited text no. 14
    
15.Smelli JM, Preece MA, Paton AM. Normal Somatic Growth in Children receiving low-dose prophylactic cotrimoxazole. Eur J Pediatr 1983; 140;301-4.  Back to cited text no. 15
    
16.Polito C, La Manna A, Zamparreli M, Papale MR, Marte A, Rocco CE. Catch-up Growth in children with vesicoureteral reflux. Pediatr Nephrol 1997;11:164-8.  Back to cited text no. 16
    
17.Menon P, Rao KLN, Bhattacharya A, Mahajan JK, Samujh R. Primary Vesicoureteral Reflux: Progress of disease, somatic growth and renal parameters. Indian Pediatr 2004;41:1025-30.  Back to cited text no. 17
    

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Correspondence Address:
Majid Malaki
Assistant Professor of Pediatric Nephrology, Tabriz Children Hospital, Post code 5136735886, Tabriz
Iran
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PMID: 21743217

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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3]

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