PEDIATRIC UROLOGY

Vesicoureteral reflux in the Hispanic child with urinary tract infection
Pinto KJ
From the Pediatric Urology Department, Urology Associates of North Texas and Cook Children’s Medical Center, Fort Worth, Texas, USA
J Urol. 2004;171: 1266-7

• Purpose: Hispanic individuals have become the largest minority in the United States. Prior studies of minorities revealed real differences in vesicouretal reflux rates between white and black Americans. We studied the incidence of reflux in the Hispanic population to see if the reflux rate was different from that of the white population.
• Materials and Methods: We reviewed the results of voiding cystourethrograms performed in Hispanic children as our normal screening for reflux and compared them to voiding cystourethrograms results in a group of white children. The children were identified as Hispanic or white by their parents on an intake form.
• Results: Of the Hispanic children 27% had vesicoureteral reflux on voiding cystogram, while 32% of the white children had vesicoureteral reflux.
• Conclusions: Hispanic patients presenting with the first urinary tract infection seem to be afflicted with vesicoureteral reflux as often as their white contemporaries. Hispanic children should be screened as aggressively as white children when they present with urinary tract infections.
  
  
• Editorial Comment
  It has become clear that vesicoureteral reflux has some genetic determinants. Although the exact mechanisms are unclear, it is apparent that within families there is a 45% chance of sibling reflux and a 65% chance of reflux in offspring of patients with reflux. Furthermore, the rate of reflux in different races is quite different, with whites having a much higher rate than blacks.
  In this context, this paper evaluates the rate of reflux in Hispanic children. The authors found that in the workup of a urinary tract infection, the chance of finding reflux was similar in Hispanic and white children. Although this suggests that there is no genetic difference, there are several caveats. Blacks not only have a lower rate of reflux but less urinary tract infections. Since this study only looks at Hispanics who had urinary infections, this study would not be able to evaluate the possibility that Hispanics might have a lower rate of infection also. Furthermore, blacks from different genetic groups appear to have different rates of reflux, so that the Hispanics in this study (primarily from Mexico) might not be representative of all Hispanics.

Dr. Barry A. Kogan
Chief and Professor of Urology and Pediatrics
Albany Medical College
Albany, New York, USA