Abstract
Background
Siblings of children with vesicoureteral reflux (VUR) are at elevated risk of VUR.
Screening siblings may identify VUR before a clinical illness such as a urinary tract
infection (UTI), but the benefit of screening has not been demonstrated. We sought
to determine the incidence of UTI among siblings, and we hypothesized that the sibling
UTI rate is similar between screened and unscreened siblings.
Methods
We performed a retrospective cohort analysis using insurance claims data (January
1, 2000, to December 31, 2009). Within each family, we identified the index VUR patient
and siblings; we included siblings who were enrolled in the insurance plan from birth
for at least 1 year. We identified siblings who were screened for VUR and/or had UTI.
We investigated the association of screening and UTI, controlling for patient characteristics
and clustering within families.
Results
Among 617 siblings (associated with 497 index patients), 317 (51%) were girls. Median
insurance enrollment time was 53.0 months, with 424 enrolled ≥3 years. Among those
with 1 or 3 years of enrollment, the proportions of siblings who experienced UTI was
8.4% (52 of 617) and 10.4% (44 of 424), respectively. Median age at initial UTI was
32.7 months. A total of 223 siblings (36.0%) underwent sibling screening. There was
no significant difference in UTI between screened and unscreened siblings (odds ratio
1.57, 95% confidence interval 0.87–2.85; P = .14). In multivariate analysis, screening was not associated with sibling UTI incidence
(odds ratio 1.33, 95% confidence interval 0.68–2.60; P = .40).
Conclusions
Although UTI is relatively common among siblings of VUR patients, there was no statistically
significant difference in UTI incidence between screened and unscreened siblings.
Keywords
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References
- Screening siblings for vesicoureteral reflux.J Urol. 2002; 168: 2138-2141
- Outcome of sibling vesicoureteral reflux.J Urol. 2002; 167: 283-284
- Vesicoureteral reflux in children: a computerized review.J Urol. 1973; 109: 888-890
- Family study of vesicoureteral reflux.J Urol. 1975; 113: 623-625
- Scintigraphic screening for renal damage in siblings of children with symptomatic primary vesico-ureteric reflux.BJU Int. 2001; 87: 463-466
- Vesicoureteral reflux in healthy infants and children.in: Hodson C.J. Kincaid-Smith P. Reflux Nephropathy. Masson, New York1979
- Familial vesicoureteral reflux–is screening beneficial?.J Urol. 2009; 182: 1673-1677
- Vesicoureteric reflux: screening of first degree relatives.Arch Dis Child. 1989; 64: 1538-1541
- The relationship of sibling reflux to index patient dysfunctional voiding.J Urol. 1988; 140: 119-120
- Results of a vesicoureteral reflux practice pattern survey among American Academy of Pediatrics, Section on Pediatric Urology members.J Urol. 1998; 160: 1031-1037
- Screening asymptomatic siblings for vesicoureteral reflux: sound science or religious rhetoric?.Can J Urol. 2006; 13: 3309-3316
- Pediatric Vesicoureteral Reflux Guidelines Panel Summary Report: clinical practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal hydronephrosis.J Urol. 2010; 184: 1145-1151
- Vesicoureteral reflux in children: incidence and severity in siblings.J Urol. 1997; 157: 2287-2290
- R: A Language and Environment for Statistical Computing.R Foundation for Statistical Computing, Vienna, Austria2013
Thearneu T. Survival: a package for Survival Analysis in R. v2.37. Available at: http://CRAN.R-project.org/package=survival. Accessed February 4, 2016.
- Modeling Survival Data: Extending the Cox Model.Springer, New York, NY2000
- Plotrix: a package in the red light district of R.R-News. 2006; 6: 8-12
- Sibling reflux: a dual center retrospective study.J Urol. 1996; 156: 677-679
- A family study of vesicoureteric reflux.J Med Genet. 1978; 15: 85-96
- Screening of asymptomatic siblings of patients with vesicoureteral reflux.Int Urol Nephrol. 1991; 23: 437-440
- Vesicoureteric reflux and renal scars in asymptomatic siblings of children with reflux.Arch Dis Child. 1992; 67: 506-508
- The long-term results of prospective sibling reflux screening.J Urol. 1992; 148: 1739-1742
- Urodynamic pattern in asymptomatic infants: siblings of children with vesicoureteral reflux.J Urol. 1999; 162: 1733-1737
- Sibling vesicoureteral reflux in multiple gestation births.Pediatrics. 2000; 105: 800-804
- The transmission of vesicoureteral reflux from parent to child.J Urol. 1992; 148: 1869-1871
- Genetics of vesicoureteral reflux.Nat Rev Urol. 2011; 8: 539-552
- Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.Pediatrics. 2011; 128: 595-610
- Infant vesicoureteral reflux: a comparison between patients presenting with a prenatal diagnosis and those presenting with a urinary tract infection.Urology. 2003; 61: 442-446
- Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children.J Urol. 2009; 182: 1535-1541
- Renal cortical abnormalities in siblings of index patients with vesicoureteral reflux.Pediatrics. 2014; 133: e933-e937
- Urinary tract infection in children.in: Litwin M.S. Saigal C.S. Urologic Diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. US Government Printing Office, Washington, DC2007: 439-458
- Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials.JAMA. 2007; 298: 179-186
- Epidemiology of symptomatic urinary tract infection in childhood.Acta Paediatr Scand Suppl. 1974; 252: 1-20
- Association between urinary symptoms at 7 years old and previous urinary tract infection.Arch Dis Child. 1991; 66: 232-234
- Accuracy of administrative billing codes to detect urinary tract infection hospitalizations.Pediatrics. 2011; 128: 323-330
Article info
Publication history
Published online: November 14, 2015
Accepted:
November 10,
2015
Received:
May 1,
2015
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
Copyright © 2016 by Academic Pediatric Association
