December 2019/ Vol 6/ Issue 12 Print ISSN: 2349-5499, Online ISSN: 2349-3267 Original Research Article Pediatric Review: International Journal of Pediatric Research Available online at: www.medresearch.in 613|P a g e Outcome of Vesico Ureteral Reflux in Children (VUR) and Idiopathic Hypercalciuria (IHC) associated with Urinary Tract Infection (UTI) in Indian Children Gupta A.K. 1 , Kumar V. 2 , Wilson C.G. 3 , Tomar R.P.S. 4 , Sahu S. 5 1 Dr. (Lt Col) Ashish Kumar Gupta, Paediatrician, Military Hospital, Secunderabad, 2 Dr. Vinay Kumar, Registrar, Rainbow Children Hospital, Banjara Hills, Hyderabad, 3 Dr. (Col) C.G. Wilson, Academic Head (DNB), Rainbow Children Hospital, Banjara Hills, Hyderabad, 4 Dr. (Col) R.P.S. Tomar, Advisor (Paediatrics & Neonatology), Military Hospital Secunderabad, 5 Dr. Sonam Sahu, Medical Officer, Regional Centre ECHS, Secunderabad. Corresponding Author: Dr. (Lt Col) Ashish Kumar Gupta, Paediatrician, Military Hospital, Secunderabad, Telangana. India. E-mail: drakg.acad@gmail.com ……………………………………………………………………………………………………………………………………... Abstract Background: Paediatric UTI associated with predisposing factors like VUR and IHC causes severe damage to renal tissues resulting in renal scars. Material and Methods: This prospective observational study was conducted from August 2017 to January 2019 in teaching military hospital and tertiary care corporate hospital was done to analyse and quantify the effects of these co-morbidities in Indian children with UTI. Results: A total 405 children of UTI were studied. 55 children (13.58%) had VUR being predominantly in the age group of 1-36 months (74.54%) with majority males (58.55%). 4 children (0.98%) had IHC. 346 children or 85.43% of sample size did not show any signs of VUR or IHC. 17 male children (56.66%) and 13 female children (43.33%) had bilateral VUR. Out of the 55 children with VUR, 26 (47.27%) developed renal scars. Conclusion: Medical management was successful in resolution of 27% of cases. All the 8 cases with Grade V VUR did not improve and required surgery. All the cases of IHC resolved spontaneously on conservative management. Keywords: Hypercalciuria, Pyelonephritis, Renal scars, Urinary tract infection, Vesico-ureteral reflux ……………………………………………………………………………………………………………………………………... Background Urinary Tract infection (UTI) is one of the most frequent diseases in paediatric age group causing long term morbidity. Febrile UTI is known to affect the kidneys causing pyelonephritis and renal scars [1]. This is especially true for the growing young vulnerable renal tissues during initial years of life. Anomalies of urinary tract such as vesico-ureteric reflux (VUR) and idiopathic hypercalciuria (IHC) are known risk factors for recurrent UTI and the risk is correlated with the severity. VUR can be an isolated finding and called primary reflux or can be associated with other urological anomalies such as posterior urethral valves or ureterocoele and referred to as secondary reflux. Association of VUR with UTI was shown to be prerequisite for renal scarring by classical study published by Ranslay and Risden in 1978 [2]. VUR with secondary bacterial infection of renal parenchyma leads to acute inflammatory reaction in the renal tissue. Manuscript received: 10 th December 2019 Reviewed: 20 th December 2019 Author Corrected: 26 th December 2019 Accepted for Publication: 31 st December 2019 This inflammation is mediated by cytokine release, resulting in focal parenchymal ischaemia and ultimately scarring. The extent of renal damage after a febrile infection depends on bacterial and host factors that mediate the response to infection. Late sequelae of renal scarring such as hypertension, proteinuria, or even chronic renal failure can be seen in the second or third decade of life [3]. Non-anatomic problems such as hypercalciuria as a cause of UTI is increasingly being recognised in recent years. Idiopathic hypercalciuria (IHC) is one of the most common causes of urolithiasis in children. It can also present with myriad of symptoms such as haematuria, voiding dysfunction, flank pain, nephrolithiasis and decreased bone mineral density [4]. In the present study were trying to determine the association of VUR and idiopathic hypercalciuria with UTI in Indian children and the outcomes by following the cases over the study period. There are no similar studies in Indian children, as most studies have focussed only on prevalence patterns and clinical profiles.