Kidney Disease Research Updates
Fall 2007

RESEARCH NEWS

NIDDK RIVUR Study Under Way

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is funding a study that is recruiting 600 children between 2 months and 6 years of age to learn whether all children with vesicoureteral reflux (VUR) should be treated with long-term antibiotics.

The Randomized Intervention for Children with Vesicoureteral Reflux (RIVUR) Study is a randomized, double-blind, placebo-controlled trial of antimicrobial prophylaxis in children with VUR and urinary tract infection (UTI).

VUR is a condition in which urine flows backward from the bladder toward the kidneys during urination. Retrograde urine flow is the most common congenital urologic abnormality in children, according to Marva Moxey-Mims, M.D., director of the NIDDK’s Pediatric Nephrology and Renal Centers Programs in the Division of Kidney, Urologic, and Hematologic Diseases.

VUR is found in 30 to 50 percent of children who have had a UTI and is thought to increase the risk of kidney damage when children have recurrent UTIs. At least 1.7 percent of boys and 8.4 percent of girls will have at least one UTI during childhood. Of these, at least 30 percent will have a recurrence.

Renal scarring occurs between 5 and 40 percent of the time and potentially may increase with each UTI. This concerns researchers because scarring can result in reflux nephropathy—kidney damage caused by retrograde urine flow—progressive renal failure, and the eventual need for renal replacement therapy.

The rationale for a multicenter trial is

• lower prevalence of scarring in children
• no drop in the number of VUR patients progressing to ESRD since the 1960s, despite the routine use of prophylactic antibiotics
• invasive, expensive, and stressful diagnostic procedures
• bacterial resistance that can result from long-term antibiotic prophylaxis

Trial participants will have primary VUR documented after the patient’s first febrile or symptomatic UTI that is appropriately treated. The trial includes five clinical treatment centers:

• Children’s Hospital of Philadelphia, Ron Keren, M.D., principal investigator
• Children’s Hospital of Pittsburgh, Alejandro Hoberman, M.D., principal investigator
• The Johns Hopkins School of Medicine, Ranjiv Mathews, M.D., principal investigator
• Wayne State University School of Medicine, Tej Mattoo, M.D., principal investigator
• Women’s and Children’s Hospital of Buffalo, Saul Greenfield, M.D., principal investigator

The data coordinating center is at the University of North Carolina, Chapel Hill, Myra Carpenter, Ph.D., principal investigator. For more information about the RIVUR study, visit www.cscc.unc.edu/rivur.

NIH Publication No. 08–4531
November 2007

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