Renal volumetry and functional impairment prediction in pediatric vesicoureteral reflux based on contrast-enhanced voiding urosonography.
A multivariable model using contrast-enhanced voiding urosonography findings showed high discrimination for renal scarring in children with vesicoureteral reflux.
Renal volumetry and functional impairment prediction in pediatric vesicoureteral reflux based on contrast-enhanced voiding urosonography.
Contrast-enhanced voiding urosonography (CeVUS) provides a radiation-free alternative for diagnosing vesicoureteral reflux (vesicoureteral reflux), but there is limited literature on its utility in evaluating renal volumetric loss and predicting split renal function (split renal function) impairment as well as renal scarring (renal scarring).
This study aimed to elucidate the impact of vesicoureteral reflux and intrarenal reflux (intrarenal reflux) on renal volume, identify independent risk factors for split renal function impairment and renal scarring, and develop a predictive model.
In this retrospective cohort study (from January 2022 to December 2024), 261 children (119 vesicoureteral reflux-positive, 142 controls) underwent CeVUS.
AUC; 1.0 is perfect, so the model separates scarred from unscarred kidneys well
Across vesicoureteral reflux grades, renal volume decreased progressively, but only high-grade vesicoureteral reflux showed a statistically significant reduction.
Among high-grade vesicoureteral reflux cases, kidneys with intrarenal reflux were smaller than those without intrarenal reflux, though not significantly (P=0.11).
Intrarenal reflux predominantly involved the upper poles (cumulative prevalence 83%) and showed strong spatial concordance with both split renal function impairment [Jaccard similarity 0.72, 95% confidence interval (CI): 0.65-0.78] and renal scarring (Jaccard similarity 0.69, 95% CI: 0.62-0.75).
High-grade vesicoureteral reflux is a primary determinant of renal volume reduction, and intrarenal reflux demonstrates a potential association with accelerated volume loss.
Crucially, frequent urinary tract infections, high-grade vesicoureteral reflux, and intrarenal reflux constitute independent risk factors for split renal function impairment, while older age independently predicts renal scarring.
The multivariable prediction model achieved strong discriminative capacity, supporting CeVUS as a comprehensive, radiation-free modality for anatomical assessment and functional risk stratification in pediatric reflux nephropathy.