|
|
 |
|||||
 |
|
||||
|
April 2008 Despite recent uncertainties about the use of antimicrobial prophylaxis for the management of vesicoureteral reflux in children, physicians should continue to treat these patients, according to Russell W. Chesney, MD. “At issue is the presence of scarring of the kidney or reflux nephropathy in patients with VUR in the absence of a urinary tract infection,” Chesney, a member of the AAP section on nephrology, told Infectious Diseases in Children. “VUR may be diagnosed after follow-up for antenatal hydronephrosis or even during sibling screening, due to the high prevalence of familial reflux. These two factors have fueled the debate over appropriate management. In addition, renal scars with a febrile UTI can occur in children without VUR, at least as conventionally performed. However, not all children with VUR will have recurrent UTIs or scarring in the kidney.” The current doubts about the management of VUR may be attributed in large part to systematic reviews of published literature. For example, data published in the Cochrane Review indicated that most of these studies have been poorly designed. The AAP, the American Urological Association and the Swedish Medical Research Council have also acknowledged the lack of evidence for the recommendation of long-term prophylaxis for VUR, but they continue to recommend use of long-term prophylaxis in the guidelines. In an attempt to evaluate the effectiveness of long-term antimicrobial prophylaxis to reduce the risk for urinary tract infection and renal scarring in children aged 1 month to 5 years, the National Institutes of Health and the National Institute of Diabetes and Digestive and Kidney Diseases have funded a randomized, placebo-controlled, double-blind study. The Randomized Intervention for Children with Vesicoureteral Reflux study is currently in the recruitment phase. “While in the midst of this potential paradigm shift in the management of VUR, there lies a risk of some practitioners not appropriately investigating young children with urinary tract infection or not using long-term antimicrobial prophylaxis in those with VUR,” Chesney said. “It is advisable that until the results of this study or any other similar study become available, VUR and UTI are considered as risk factors for renal scarring and each patient is treated with prudence.” |
