Familial vesicoureteral reflux--is screening beneficial?

PURPOSE: The familial nature of vesicoureteral reflux is well recognized. Screening siblings for reflux is controversial. We identified a group of siblings of index patients with vesicoureteral reflux who are most likely to be affected. We also identified risk factors for renal scarring.

MATERIALS AND METHODS: Between 1998 and 2007 the parents of 215 index patients with grades III to V vesicoureteral reflux were asked permission to screen siblings younger than 6 years for reflux. The 251 siblings with reflux were divided into those who were diagnosed following a urinary tract infection and those who were screened. Siblings were also divided into those younger than 3 years and those 3 to 6 years old at diagnosis. Dimercapto-succinic acid scans were available in 172 index patients and in 180 siblings.

RESULTS: Of the 251 siblings with reflux 105 and 146 were diagnosed after a urinary tract infection and after screening, respectively. A total of 207 siblings (82.5%) were younger than 3 years and 44 (17.5%) were 3 to 6 years old. There were 79 symptomatic siblings (75.2%) younger than 3 years and 26 (24.8%) who were 3 to 6 years old. Of the screened siblings with reflux 128 (87.7%) were younger than 3 years and 18 (12.3%) were 3 to 6 years old. Renal scarring was seen in 35.5% of symptomatic siblings compared to 15% of screened siblings.

CONCLUSIONS: The incidence of sibling VUR is maximal in patients who are younger than 3 years. Reflux in symptomatic siblings who are younger than 3 years is usually high grade and associated with a higher incidence of renal scarring. We recommend screening all siblings who are younger than 3 years of index patients with grades III to V vesicoureteral reflux.