Screening Guidelines Offered for Urinary Tract Conditions

Focus on relatives of patients with vesicoureteral reflux and infants with prenatal hydronephrosis
By Jeff Muise
HealthDay Reporter

MONDAY, Aug. 30 (HealthDay News) -- The American Urological Association (AUA) has published new guidelines for the screening of siblings and offspring of index patients with vesicoureteral reflux (VUR) and infants with prenatal hydronephrosis (PNH) in the September issue of The Journal of Urology.

Steven J. Skoog, M.D., of AUA Education and Research Inc. in Linthicum, Md., and colleagues on the association's Vesicoureteral Reflux Guideline Update Committee performed a database search for relevant articles published from 1994 to 2008. After performing a meta-analysis, they formulated the extracted data into evidence-based screening recommendations.

The panel recommended that siblings of children with VUR have a voiding cystourethrogram (VCUG) or radionuclide cystogram if there is ultrasound evidence of renal cortical abnormalities or renal size asymmetry, or a history of urinary tract infection (UTI). However, as the value of treating VUR is unproven, clinicians may also opt for: 1) an observational approach with treatment as indicated, 2) screening simply to identify the condition, or 3) ultrasound screening of the sibling's kidneys to identify scarring. The same guidelines would apply to offspring of VUR patients. The panel also recommended VCUG screening for infants with high-grade PNH, hydroureter or abnormal bladders on ultrasound, or UTI. An observational approach, with treatment of UTI, also may be used with PNH.

"Recommendations for screening are limited by the uncertainty of any potential benefit gained by identifying VUR. Identification of VUR may increase the awareness of parents and health providers to the potentially increased risk of pyelonephritis and renal scarring," the authors write.

Several of the panel members reported financial ties to pharmaceutical and/or medical device companies.

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