Influence of vesico-ureteral reflux on growth

Vesico-ureteral reflux (VUR) is the most common urologic abnormality seen in children. It represents the backflow of urine from bladder to upper urinary structures due to a defect in closure of uretero-vesical junction. This condition predisposes children to repetitive pyelonephritis associated with renal scarring. Studies are continuously searching for the potential effect of VUR on growth. We aimed to assess growth indices: height z-score (HZ), Ideal body weight percent (IBWp) and percent of actual weight over median weight for age (MWAp) in children with VUR at presentation and at time of study and to compare them with those of children with pyelonephritis without VUR. We included children aged between 0 and 6 years old with a normal renal function admitted in our center for pyelonephritis. However, children with chronic diseases affecting growth were excluded. The children who met above criteria (112 children) were divided into 3 groups according to voiding cystourethrogram results: G1( VUR grade 1-2 ), G2(VUR grade 3 , 4 , 5) and G3 (no VUR). Our data showed no significant difference between the 3 groups concerning sex, age groups, consanguinity, gestational age, height and weight at birth. However, we noted a strong association between VUR and ESBL infection (p=0.0001), and history of previous pyelonephritis (p=0.0357). Growth indices HZ and MWAp were significantly lower in G2 than in other groups at presentation and at time of study (p=0.0001) for both. In contrast, no significant change was detected in IBWp neither at presentation nor at time of study. No significant association was found between reflux laterality and growth indices. We also noted a significant improvement in HZ (p=0.01) and in MWAp (p=0.0168) following surgical treatment, while no significant change was recorded in growth indices following antibiotic prophylaxis.