A follow-up study of vesico-ureteric reflux and renal scars in asymptomatic siblings of children with reflux.

The objectives of this study were to follow up children with vesico-ureteric reflux (VUR) and renal scars, to evaluate kidney growth and to determine the incidence of urinary tract infection (UTI) and elevated blood pressure in 40 asymptomatic siblings of children with VUR, in whom VUR had been detected at an early age, and to gather additional data which could help to evaluate the need for screening for VUR in asymptomatic siblings. During the follow-up period of 3-7 years, two children (5%) had UTI; 66% of VUR grade 1 and 2 disappeared. The progression of scars was only detected in two of nine children with renal scars on the initial study, both of whom had high-grade VUR. Renal ultrasound was normal in all siblings and none developed hypertension. The results indicate that low-grade sterile VUR may not play a major role in renal scarring, but this may not be the case with high-grade sterile VUR. Considering the correlations among VUR, UTI and reflux nephropathy, routine screening for VUR at an early age in asymptomatic siblings of children with VUR seems to be justified to identify those at the greatest risk of subsequent renal damage.