World Kidney Day 2016: Kidney Disease & Children. Act Early to Prevent It!
World Kidney Day 2016: Kidney Disease & Children. Act Early to Prevent It! • Kidney disease affects millions of people worldwide, including many children who may be at risk at an early age. It is therefore crucial that we encourage and facilitate education, early detection and a healthy life style in children, to fight the increase of preventable kidney diseases and to treat children with inborn and acquired disorders of the kidneys worldwide.
Pediatric Kidney Disease – An Update Edited by the ASPN Clinical Affairs Committee
Vesicoureteral Reflux (VUR) and UTIs • David Hains, MD • LeBonheur Children’s Hospital, University of Tennessee Health Science Center
VUR/UTIs: Background Vesicoureteral reflux (VUR): • Abnormal backflow of urine • Prevalence is at least 1-2% Craig JC, et al. J Am SocNephrol 19: 847–862, 2008
UTI Epidemiology • 8% girls/2% boys have UTI in first 6 yrs of life. • >1.4 million annual physician office visits ($8 Billion). • ~50,000 children hospitalized annually with UTI diagnosis. • Estimated annual economic burden of inpatient treatment: ~$180 million Montiniet al. NEJM 2011; 365(3) AAP Clinical Practice Guideline. Pediatrics 2011; 128(3) Freedman et al. J. Urology 2005; 173(3) Spencer et al. PedNeph 2010; 25(12)
VUR: Complications UTIs Scarring CKD/ ESRD Hypertension http://www.medscape.org/viewarticle/432641
VUR Management • Goals: • Prevent UTIs • Limit side effects • Prevent renal scarring • Strategies: • Antibiotic prophylaxis • Conservative management • Corrective procedures Recurrence, 29% No recurrence, 71% Estrada CR, et al. Journal of Urology 181:229, 2009 Lee RS, et al. Pediatrics 118:586, 2006 Penido Silva JM, et al. PediatrNephrol 21:86, 2006
RIVUR Outcomes by Treatment Group Hoberman et al. N Engl J Med. 2014 Sep11;371(11):1072-3. Slide from Russell Chesney
VUR and UTI Summary • There are still unanswered questions regarding an optimal evaluative and therapeutic approach. • An appropriate strategy must be tailored to the individual patient and family. • Don’t forget to ask about dysfunctional elimination syndrome and address it if needed!
Happy World Kidney Day 2016! Your pediatric nephrology community continues to work hard to improve clinical care, foster education, and advance the science regarding kidney disease in children! We appreciate your support and all you do for children’s health care!