Gender and vesico-ureteral reflux: a multivariate analysis |
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Authors: | Jose Maria Penido Silva Eduardo Araujo Oliveira Jose Silverio Santos Diniz Luis Sergio Bahia Cardoso Renata Moura Vergara Mariana Affonso Vasconcelos Daniela Espirito Santo |
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Institution: | (1) Pediatric Nephro-urology Unit, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil;(2) CNPq Fellowship, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, Brazil;(3) Rua Engenheiro Amaro Lanari 389/501, Belo Horizonte, Minas Gerais, 30.310.580, Brazil |
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Abstract: | The aim of this retrospective cohort study was to describe the characteristics of patients with primary vesico-ureteral reflux
(VUR) with special attention to gender-specific differences. Between 1970 and 2004, 735 patients were diagnosed with VUR and
were systematically followed in a single tertiary renal unit. The following variables were analyzed: race, age at diagnosis,
clinical presentation, weight and height Z-score, unilateral/bilateral reflux, VUR grade, renal damage, severity of renal
damage, constipation, and dysfunctional voiding. Comparison of proportion between genders was assessed by the chi-square test
with Yates’ correction. The logistic regression model was applied to identify independent variables associated with gender.
A survival analysis was performed to evaluate VUR resolution. After adjustment, five variables remained independently associated
with male gender at baseline: non-white race Odds ratio (OR) = 1.98, 95% confidence interval (95% CI) 1.33–2.95, P=0.001], moderate/severe grade of reflux (OR=2.16, 95% CI 1.45–3.22, P<0.001), severe renal damage (OR=1.60, 95% CI 1.04–2.52, P=0.04), age at diagnosis <24 months (OR=1.79, 95% CI 1.23–2.60, P=0.002), and antenatal clinical presentation (OR=3.56, 95% CI 1.91–6.63, P<0.001). Follow-up data were available for 684 patients (93%). Median follow-up time was 69 months (range 6 months to 411
months). Girls had a greater risk of urinary tract infection (UTI) during follow-up than boys (OR=1.68, 95% CI 1.18–2.38,
P=0.003). There was no difference in progression to chronic renal insufficiency (CRI) between boys (3.8%) and girls (2.4%)
during this period of follow-up (OR=1.58, 95% CI 0.59–4.15, P=0.44). Gender as an isolated variable is a poor predictor of clinical outcome in an unselected series of primary reflux.
Although boys had a more severe pattern at baseline, girls had a greater risk of dysfunctional voiding and recurrent UTI during
follow-up. |
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Keywords: | Vesico-ureteral reflux Gender Reflux nephropathy Urinary tract infection Voiding dysfunction |
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