Archives of Disease in Childhood 2008;93:196-199
Leading articles
Is reflux nephropathy preventable, and will the NICE childhood UTI guidelines help?
Department of Paediatric Nephrology, Royal Victoria Infirmary, Newcastle, NE1 4LP UK; malcolm.coulthard@nuth.nhs.uk
Accepted 24 September 2007
| The first 150 words of the full text of this article appear below. |
The strong association between childhood urinary tract infection (UTI), vesicoureteric reflux (VUR) and kidney scarring has been recognised for many years,1 2 but their relationship is inconsistent. This is in part because many infants with UTIs only have non-specific symptoms and are not diagnosed, in part because children may scar while they have VUR and subsequently outgrow it,3 and in part because some dysplastic lesions are present from birth. The relationship was also in part unexplained because some kidneys were recognised not to scar despite having VUR and recurrent UTIs. Particularly striking are children with severe bilateral VUR where one kidney is extensively damaged and the other is pristine. Ransley and Risdon’s piglet experiments in the 1970s provided a possible explanation for these variations.4
By inducing unilateral VUR surgically in piglets and then introducing a bladder infection, Ransley and Risdon showed that the combination of VUR and a UTI caused coarse
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