Detecting vesico-ureteral reflux in asymptomatic siblings of children with reflux by direct radionuclide cystography

The incidence of vesicoureteral reflux (VUR) among asymptomatic siblings of children with VUR is much higher than the estimated incidence in the general population. It might be expected that identifying them and keeping them under close observation and/or either surgical or conservative treatment, might reduce the risk of renal scarring. Fifty-three asymptomatic children, all under 6 years of age and all siblings of children with proven VUR, were studied with direct radionuclide voiding cystography (DRVC). There were 31 (58%) boys, and 22 (42%) girls. Nine children (17%) were younger than 1 year, 13 (25%) were between 1 and 2 years of age, while 31 (58%) were older than 2 years. VUR was detected in 22 (42%) of the 53 siblings. The incidence of VUR varied considerably according to the age, and sex of the child, the highest being in boys younger than 1 year. Most of the severe reflux was seen in children under 2 years of age. Out of 11 patients with VUR, grade 2 and 3, there were 10 younger than 2 years, whereas, only 2 of the 11 siblings with VUR, grade 1 were younger than 2 years of age. The mean age of children with VUR grades 2 and 3 was 19 months, compared to the mean age of 50 months for those with VUR grade 1. DRVC, a highly sensitive method, exposes the patient to much less radiation than X-ray voiding cystography. We believe that the benefit of detecting VUR in asymptomatic siblings with DRVC outweights the invasiveness of the procedure. The predictive value of positive family history alone in identifying VUR in our study was 42%. This appears high enough to justify the routine investigation of asymptomatic siblings of children with VUR using DRVC at an early age.