Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR): background commentary of RIVUR investigators

Abstract

Because of the frequency of urinary tract infections in children, off-label use of antimicrobial prophylaxis is often the usual treatment of children with vesicoureteral reflux, and such use is increasingly being called into question; hence, a definitive study to determine the value of antimicrobial prophylaxis with regard to the recurrence of urinary tract infection and the incidence of renal scarring is essential. The currently recommended follow-up procedures (repeated urine cultures, renal and genitourinary imaging, antimicrobial therapy and prophylaxis, as well as other factors including cleanliness, adequate bladder and bowel emptying, and compliance with protocols) are expensive (in terms of time, attention to detail, and cost) and cumbersome. Such recommendations should be evidence-based.

Figure 1

Theoretical model showing how urinary stasis caused by VUR leads to bacterial growth in the renal parenchyma. Macrophages and leukocytes migrate to the interstitium and secrete pro-inflammatory cytokines, resulting in fibrosis and scarring with a progressive decline in renal function and the development of proteinuria and hypertension. In reality, only a minority of children with primary VUR develop scarring.