Wanted to share some thoughts on our recent publication in JAMA Pediatrics "Glomerular Filtration Rate Changes Following UTI in Children With Vesicoureteral Reflux" which we presented at Kidney Week and published simultaneously. jamanetwork.com/journals/jam... - ThreadSky

mcstarr1.bsky.social • 110 days ago

Wanted to share some thoughts on our recent publication in JAMA Pediatrics "Glomerular Filtration Rate Changes Following UTI in Children With Vesicoureteral Reflux" which we presented at Kidney Week and published simultaneously. https://jamanetwork.com/journals/jamapediatrics/fullarticle/2825378

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mcstarr1.bsky.social•110 days ago

Also thanks to @kidneyboy.bsky.social and the @nephjc.bsky.social team for stopping by our Late Breaker and also highlighting this work on a pretty cool (in my opinion) #NephJC Rewind. Have gotten some questions about the study, so figured I would do a quick thread. http://www.nephjc.com/news/2024/10/29/nephjc-rewind-the-rivur-trial

nephroseeker.medsky.social•110 days ago

Not the best picture, but it was a glorious #nephjc poster tour finish 😊

mcstarr1.bsky.social•110 days ago

What did we do? We took publicly available data from the RIVUR study (foundational #pedsneph study looking at reflux and febrile UTIs) at looked at intra-patient GFR changes. Previous analysis had looked at POOLED (or population wide changes) but no one had looked at what happens WITHIN a patient.

mcstarr1.bsky.social•110 days ago

Why did we do this? Population GFR change doesn't tell us much about the impact of a UTI (or multiple UTIs) in patients. Furthermore, as GFR matures during the first year or two of life, we had concerns that a pooled analysis may miss a signal. Turns out, this concern was right.

mcstarr1.bsky.social•110 days ago

So what did we find? We found that kids with VUR and more than one UTI had an eGFR DROP of 12.3 mL/min/1.73 m² more than those with ≤1 UTI. Even more interestingly, we saw the strongest association (even after controlling for other factors!) in children NOT on prophylaxis.

mcstarr1.bsky.social•110 days ago

While RIVUR wasn't powered to answer these questions, it's important to note that we didn't see an association between DMSAs and GFR change either. DMSA may not be the best marker in this population and kidney function change (eGFR) may be a better (and more proximate!) assessor of damage.

mcstarr1.bsky.social•110 days ago

What's next? We need bigger studies that focus on GFR and kidney function in these patients. We are hopeful that our re-analysis of existing data starts to get people thinking more about the impact of UTIs and the role of prophylaxis in this patient population!

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