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Saudi Journal of Kidney Diseases and Transplantation
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Table of Contents   
LETTER TO THE EDITOR  
Year : 2013  |  Volume : 24  |  Issue : 3  |  Page : 600-601
Risk factors for renal scarring in children with primary vesicoureteral reflux disease


Professor in Pediatrics and Child Health, Consultant Pediatrician, Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad, Iraq

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Date of Web Publication24-Apr-2013
 

How to cite this article:
Al-Mendalawi MD. Risk factors for renal scarring in children with primary vesicoureteral reflux disease. Saudi J Kidney Dis Transpl 2013;24:600-1

How to cite this URL:
Al-Mendalawi MD. Risk factors for renal scarring in children with primary vesicoureteral reflux disease. Saudi J Kidney Dis Transpl [serial online] 2013 [cited 2019 Oct 20];24:600-1. Available from: http://www.sjkdt.org/text.asp?2013/24/3/600/111082
To the Editor,

I have two comments on the interesting paper by Mir et al [1] on the risk factors for renal scar­ring in children with primary vesicoureteral reflux (VUR) disease.

First, apart from recurrence of urinary tract infections and VUR severity proved to be sig­nificant risk factors for renal scarring in chil­dren with VUR in Mir et al's study, [1] the pos­sible relationship between the angiotensin-converting enzyme (ACE) gene insertion/deletion polymorphism and renal scarring secondary to VUR has recently attracted ample attention and the DD genotype was postulated to be a risk factor for renal scarring. This issue has been extensively studied in a Turkish cohort. Although renal scarring is not common in low-grade VUR patients, there may be scarring in some patients. DD polymorphism of the ACE gene is proved to be a significant risk factor in low-grade VUR Turkish children with renal scarring. [2]

Second, Mir et al [1] had stated in their study that the rate of familial tendency for VUR was found in 7.7% and it was 42.8% in children with renal scarring. Though such reported prevalence of VUR among siblings of index patients with VUR is still within the usual range of 4.7%-51% reported worldwide, [3] it still elicits deep concerns in terms of devas­tating outcomes of VUR, if left undiagnosed. The incidence of sibling VUR was found to be maximal in patients who are younger than three years. Reflux in symptomatic siblings who are younger than three years is usually of high grade and associated with a higher inci­dence of renal scarring. Therefore, screening all siblings who are younger than three years of index patients with grades III-V VUR has been recommended. [4] I presume that such screening needs to be seriously considered among siblings of index patients with VUR in Turkey in order to minimize the long-term risks of reflux, in particular, hypertension and end-stage renal failure.

 
   References Top

1.Mir S, Ertan P, Ozkayin N. Risk factors for renal scarring in children with primary vesicoureteral reflux disease. Saudi J Kidney Dis Transpl 2013;24:54-9.  Back to cited text no. 1
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2.Erdoðan H, Mir S, Serdaroðlu E, Berdeli A, Aksu N. Is ACE gene polymorphism a risk factor for renal scarring with low-grade reflux? Pediatr Nephrol 2004;19:734-7.  Back to cited text no. 2
    
3.Ataei N, Madani A, Esfahani ST, et al. Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux. Pediatr Nephrol 2004;19:1127-31.  Back to cited text no. 3
    
4.Menezes M, Puri P. Familial vesicoureteral reflux: Is screening beneficial? J Urol 2009; 182(4 Suppl):1673-7.  Back to cited text no. 4
    

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Correspondence Address:
Mahmood Dhahir Al-Mendalawi
Professor in Pediatrics and Child Health, Consultant Pediatrician, Department of Pediatrics, Al-Kindy College of Medicine, Baghdad University, Baghdad
Iraq
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DOI: 10.4103/1319-2442.111082

PMID: 23640645

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