PDF(Pubmed)
Abstract：
Vesicoureteral reflux (VUR) is defined as the urine backflow from the urinary bladder to the pyelo-caliceal system. In contrast, intrarenal reflux (IRR) is the backflow of urine from the renal calyces into the tubulointerstitial space. VURs, particularly those associated with IRR can result in reflux nephropathy when accompanied by urinary tract infection (UTI). The prevalence of IRR in patients with diagnosed VUR is 1-11% when using voiding cystourethrography (VCUG), while 11.9-61% when applying the contrast-enhanced voiding urosonography (ceVUS). The presence of IRR diagnosed by VCUG often correlates with parenchymal scars, when diagnosed by a 99mTc dimercaptosuccinic acid scan (DMSA scan), mostly in kidneys with high-grade VURs, and when diagnosed by ceVUS, it correlates with the wide spectrum of parenchymal changes on DMSA scan. The study performed by both ceVUS and DMSA scans showed IRRs associated with non-dilated VURs in 21% of all detected VURs. A significant difference regarding the existence of parenchymal damage was disclosed between the IRR-associated and IRR-non-associated VURs. A higher portion of parenchymal changes existed in the IRR-associated VURs, regardless of the VUR grade. That means that kidneys with IRR-associated VURs represent the high-risk group of VURs, which must be considered in the future classification of VURs. When using ceVUS, 62% of places where IRR was found were still unaffected by parenchymal changes. That was the basis for our recommendation of preventive use of long-term antibiotic prophylaxis until the IRR disappearance, regardless of the VUR grade. We propose a new classification of VURs using the ceVUS method, in which each VUR grade is subdivided based on the presence of an IRR.
摘要：
膀胱输尿管反流（VUR）定义为从膀胱到肾盂-肾盂系统的尿液回流。相比之下,肾内反流（IRR）是尿液从肾盏进入肾小管间质的回流。VUR,特别是那些与IRR相关的患者，当伴有尿路感染（UTI）时，可导致反流性肾病。使用排尿膀胱尿道造影（VCUG）时，诊断为VUR的患者的IRR患病率为1-11％，而应用对比增强排尿尿路超声造影（ceVUS）时的比例为11.9-61％。VCUG诊断的IRR的存在通常与实质疤痕相关，当通过99mTc二巯基琥珀酸扫描（DMSA扫描）诊断时，主要在具有高级VUR的肾脏中，当被ceVUS诊断时，它与DMSA扫描中实质变化的广谱相关。通过ceVUS和DMSA扫描进行的研究显示，在所有检测到的VUR中，有21％的IRR与非扩张的VUR相关。在IRR相关和IRR非相关的VURs之间，关于实质损伤的存在存在显着差异。在IRR相关的VUR中存在较高比例的实质变化，不管VUR等级。这意味着具有IRR相关VUR的肾脏代表了VUR的高危人群，在未来的VUR分类中必须考虑这一点。使用ceVUS时，发现IRR的地方有62％仍不受实质变化的影响。这是我们建议长期预防性使用抗生素直到IRR消失的基础，不管VUR等级。我们提出了一种使用ceVUS方法对VUR进行新分类的方法，其中每个VUR等级根据IRR的存在进行细分。
