Ataei N et al. (2004) Screening for vesicoureteral reflux and renal scars in siblings of children with known reflux. Pediatr Nephrol 19: 1127–1131

Siblings of children with vesicoureteral reflux (VUR) are at increased risk of developing the condition, but it is unclear whether all siblings should be screened. Some studies have shown a lower incidence of reflux in siblings over 5 years of age, and it has been suggested that cystogram screening should not be performed in these children unless they have a history of UTI or abnormal ultrasound. Ataei and colleagues have prospectively studied the incidence and severity of reflux in 40 siblings of 34 index patients, comparing the results from children aged 0–6 years with those over 6 years of age.

Once the index patients had been diagnosed with VUR, their siblings were screened with an awake VCUG or by direct radionuclide cystography. VUR was diagnosed in 17 (42.5%) of the siblings and the prevalence was similar in younger and older children. Seven children in this group had a history of symptomatic UTI. All but one of the VUR-positive children were further investigated by DMSA scintigraphy, which revealed abnormalities in 11 (68.8%) cases.

These findings challenge the view that older siblings are unlikely to suffer from reflux, and the authors suggest that children over 6 years of age will benefit from screening for the condition, whether or not they have symptoms of UTI. The development of renal scarring in children with VUR may then be prevented using prophylactic antibiotic treatment or early ureteric reimplantation.