Wang Zhengyan,Wang Wenjing,Xia Sili,et al.A preliminary study of contrast-enhanced voiding urosonography combine with serum cystatin C in the evaluation of renal damage caused by vesicoureteral reflux in children[J].Journal of Clinical Pediatric Surgery,,():452-456.[doi:10.3760/cma.j.cn101785-202506005]
A preliminary study of contrast-enhanced voiding urosonography combine with serum cystatin C in the evaluation of renal damage caused by vesicoureteral reflux in children
- Keywords:
- Vesico-Ureteral Reflux; Urography; Cystatin C; Surgical Procedures; Operative; Child
- Abstract:
- Objective Toexplore the detecting value of contrast-enhanced voiding urosonography (ceVUS) plus serum cystatin C (Cys C) in evaluating vesicoureteral reflux (VUR) and associated renal damage in children.Methods A retrospective case series study was conducted,including 458 children with recurrent urinary tract infections hospitalized from December 2019 to March 2025.And ceVUS was employed for assessing VUR grade and confirming the presence of intrarenal reflux (IRR).Among them,180 children also had serum Cys C and serum creatinine (Scr) level was measured.And χ2 test was utilized for inter group comparisons,Spearman’s correlation analysis for evaluating relationships among indicators and ROC curve analysis for assessing diagnostic performance.Results ceVUS accurately evaluated the anatomical grading of VUR,demonstrating a significant positive correlation with the incidence of IRR (r=0.680,P<0.01).In terms of functional assessment,serum Cys C spiked significantly in children with bilateral high grade VUR and demonstrated a moderate positive correlation with VUR severity (r=0.435,P<0.01).When vesicoureteral reflux reached Grade Ⅲ,the risk of IRR rose significantly.The overall abnormality rate of Cys C (35.3%) was much higher than that of Scr (3.9%),indicating that Cys C was more sensitive in detecting early VUR associated renal impairment.ROC curve analysis revealed that Cys C had some efficacy in identifying bilateral high grade reflux (AUC=0.800). Conclusion Combining ceVUS with serum Cys C for evaluation enables risk stratification of VUR children from both anatomical and functional perspectives,providing rationales for non-invasive and precise managements.
References:
[1] Spencer JD, Schwaderer A, McHugh K, et al.The demographics and costs of inpatient vesicoureteral reflux management in the USA[J].Pediatr Nephrol, 2011, 26(11):1995-2001.DOI:10.1007/s00467-011-1900-3.
[2] Gnech M, ’t Hoen L, Zachou A, et al.Update and summary of the European Association of Urology/European Society of Paediatric Urology Paediatric guidelines on vesicoureteral reflux in children[J].Eur Urol, 2024, 85(5):433-442.DOI:10.1016/j.eururo.2023.12.005.
[3] Puri P, Friedmacher F, Farrugia MK, et al.Primary vesicoureteral reflux[J].Nat Rev Dis Primers, 2024, 10(1):75.DOI:10.1038/s41572-024-00560-8.
[4] Kim D, Choi YH, Choi G, et al.Contrast-enhanced voiding urosonography for the diagnosis of vesicoureteral reflux and intrarenal reflux: a comparison of diagnostic performance with fluoroscopic voiding cystourethrography[J].Ultrasonography, 2021, 40(4):530-537.DOI:10.14366/usg.20157.
[5] 邹翔宇, 孙佩璇, 石静, 等.排尿性尿路超声造影对儿童原发性膀胱输尿管反流的诊断价值[J].临床小儿外科杂志, 2022, 21(2):151-155.DOI:10.3760/cma.j.cn101785-202006044-010. Zou XY, Sun PX, Shi J, et al.Role of contrast-enhanced voiding urosonography in the diagnosis of pediatric vesicoureteral reflux[J].DOI:10.3760/cma.j.cn101785-202006044-010.
[6] Skidmore M, Spencer S, Desborough R, et al.Cystatin C as a marker of kidney function in children[J].Biomolecules, 2024, 14(8):938.DOI:10.3390/biom14080938.
[7] Ghazi L, Farhat K, Hoenig MP, et al.Biomarkers vs machines: the race to predict acute kidney injury[J].Clin Chem, 2024, 70(6): 805-819.DOI: 10.1093/clinchem/hvad217.
[8] 中华医学会小儿外科学分会泌尿外科学组.儿童原发性膀胱输尿管反流专家共识[J].临床小儿外科杂志, 2019, 18(10):811-816.DOI: 10.3969/j.issn.1671-6353.2019.10.002. Pediatric Urology Group, Branch of Pediatric Surgery, Chinese Medical Association.Expert consensus on management of primary vesicoureteral reflux in children[J].J Clin Ped Sur, 2019, 18(10): 811-816.DOI: 10.3969/j.issn.1671-6353.2019.10.002.
[9] 王辉, 牛嘉慧.儿童泌尿系感染与膀胱输尿管反流[J].中国实用儿科杂志, 2025, 40(1):25-31.DOI:10.19538/j.ek2025010604. Wang H, Niu JH.Urinary tract infections and vesicoureteral reflux in children[J].Chin J Pract Pediatr, 2025, 40(1):25-31.DOI:10.19538/j.ek2025010604.
[10] Nino F, Ilari M, Noviello C, et al.Genetics of vesicoureteral reflux[J].Curr Genomics, 2016, 17(1):70-79.DOI:10.2174/1389202916666151014223507.
[11] 夏斯莉, 周建敏, 王勤, 等.声学造影诊断小儿膀胱输尿管反流及预测肾脏瘢痕的价值初探[J].中国超声医学杂志, 2022, 38(2):173-176.DOI:10.3969/j.issn.1002-0101.2022.02.018. Xia SL, Zhou JM, Wang Q, et al.Diagnostic value of contrast-enhanced ultrasound of urinary tract in vesicoureteral reflux and prediction of renal scarring in children[J].Chin J Ultrasound Med, 2022, 38(2):173-176.DOI:10.3969/j.issn.1002-0101.2022.02.018.
[12] Saraga M, Saraga-Babic＇ M, Arapovic＇ A, et al.The intrarenal reflux diagnosed by contrast-enhanced voiding urosonography (ceVUS): a reason for the reclassification of vesicoureteral reflux and new therapeutic approach?[J].Biomedicines, 2024, 12(5):1015.DOI:10.3390/biomedicines12051015.
[13] Simicic Majce A, Arapovic A, Saraga-Babic M, et al.Intrarenal reflux in the light of contrast-enhanced voiding urosonography[J].Front Pediatr, 2021, 9:642077.DOI:10.3389/fped.2021.642077.
[14] 季丽娜, 曹力, 陈大坤, 等.膀胱输尿管反流高危患儿的临床和影像学检查结果分析[J].中华儿科杂志, 2011, 49(4):282-286.DOI:10.3760/cma.j.issn.0578-1310.2011.04.010. Ji LN, Cao L, Chen DK, et al.Evaluation of clinical and imaging examination in high-risk children with vesicoureteral reflux[J].Chin J Pediatr, 2011, 49(4): 282-286.DOI:10.3760/cma.j.issn.0578-1310.2011.04.010.
[15] 叶菁菁, 徐彬.超声新技术在儿科领域中的应用[J].现代实用医学, 2020, 32(11):1305-1308.DOI:10.3969/j.issn.1671-0800.2020.11.002. Ye JJ, Xu B.Application of new ultrasound technologies in the pediatric field[J].Mod Pract Med, 2020, 32(11):1305-1308.DOI:10.3969/j.issn.1671-0800.2020.11.002.
[16] El-Sadek AE, El-Gamasy MA, Behiry EG, et al.Plasma cystatin C versus renal resistive index as early predictors of acute kidney injury in critically ill neonates[J].J Pediatr Urol, 2020, 16(2):206.e1-206.e8.DOI:10.1016/j.jpurol.2019.12.001.
[17] Zaitoun T, Megahed M, Elghoneimy H, et al.Renal arterial resistive index versus novel biomarkers for the early prediction of sepsis-associated acute kidney injury[J].Intern Emerg Med, 2024, 19(4):971-981.DOI:10.1007/s11739-024-03558-y.
[18] 徐虹, 张欣, 陈宏.膀胱输尿管反流的精准诊治进展[J].中华肾病研究电子杂志, 2016, 5(2):56-60.DOI:10.3877/cma.j.issn.2095-3216.2016.02.003. Xu H, Zhang X, Chen H.Advances of precise diagnosis and treatment for vesicoureteral reflux[J].Chin J Kidney Dis Investig (Electronic Edition), 2016, 5(2):56-60.DOI:10.3877/cma.j.issn.2095-3216.2016.02.003.
[19] van der Weijden J, Mazhar F, Fu EL, et al.Early compensatory increase in single-kidney estimated GFR after unilateral nephrectomy is associated with a lower long-term risk of estimated GFR decline[J].Nephrol Dial Transplant, 2025, 40(9):1680-1687.DOI:10.1093/ndt/gfaf026.
Memo
收稿日期:2025-6-4。
通讯作者:陆双泉,Email:lushuangquan0504@sina.com