Vesicoureteral Reflux in Children with Accidental Diagnosis of Unilateral Small Size Kidney

TL;DR

This study found that many children with small kidneys had an accidental diagnosis and a high rate of vesicoureteral reflux, suggesting a link between the two conditions.

Contribution

The study highlights the importance of evaluating vesicoureteral reflux in children with accidentally diagnosed small kidneys.

Findings

32.6% of children with small kidneys had vesicoureteral reflux.

Boys were more likely to have vesicoureteral reflux than girls.

E. coli was the most common cause of urinary tract infections in these children.

Abstract

A majority of small size kidney in children were diagnosed after a urinary tract infection (UTI) and with high-grade vesicoureteral reflux (VUR). This study was conducted in children who were diagnosed accidentally and investigated for VUR and UTI.

This longitudinal retrospective study was conducted in children with a diagnosis of a small kidney accidentally discovered by ultrasonography and referred to Children’s Hospital in Babol, Iran, between 2012-2022. They were investigated by DMSA (dimercapto succinic acid) renoscintigraphy scans. Vesicoureteral reflux was diagnosed by voiding C\cystourethrography (VCUG) or radionuclide cystography (RNC). All children were followed for at least for 1 year with urine culture and urinalysis every 1-2 months for detection of UTI. Significance was set at P less than .05.

The mean age of the children with small-size kidneys was 5.52 ± 3.70 years, and 58.1% were boys. Out of the 86 children, 28 (32.6%) were found to have VUR, with approximately 71.4% of them being boys. Breaking down by gender, 40% of boys and 28.6% of girls with small-sized kidneys had VUR. Among the children with and without VUR, 42.9% and 10.3% experienced UTIs, respectively (P = .74). The predominant causative microorganism for UTIs was Escherichia coli (55.6%), with Klebsiella (22.4%) and Enterobacter (22.4%) accounting for the remaining cases.

Accidental diagnoses of small-size kidneys in children revealed a notable presence of VUR, with a higher prevalence in boys. This suggests that VUR may constitute a significant etiological factor in the development of small-size kidneys. We recommend that these children must be evaluated for VUR.

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