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The RIVUR trial: a factual interpretation of our data

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Abstract

Vesicoureteral reflux (VUR) increases the risk of urinary tract infection (UTI) and renal scarring. Many prospective studies have evaluated the role of antimicrobial prophylaxis in the prevention of recurrent UTI and renal scarring in children with VUR. Of these, the RIVUR trial was the largest, randomized, placebo-controlled, double blind, multicenter study, involving 607 children aged 2–72 months with grade I–IV VUR and a first or second symptomatic UTI. The median age of children in the RIVUR trial was 12 months, 92 % were female, 91 % were randomized after a first UTI, 86 % had a febrile index UTI, and 71 (56 %) of 126 toilet-trained children had bladder bowel dysfunction. Trimethoprim/sulfamethoxazole reduced the risk of UTI recurrences by 50 % (hazard ratio 0.50; 95 % confidence interval 0.34–0.74) as compared to placebo. No significant difference was seen in renal scarring between the two groups. However, this does not invalidate the role of prophylaxis in preventing renal scars because RIVUR and other recent prospective studies were not designed to address renal scarring as a primary study endpoint. In view of the RIVUR Trial and other studies that showed similar results, albeit in selected groups of patients, the debate on antimicrobial prophylaxis should shift from “no prophylaxis” to “selective prophylaxis” in children with VUR.

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Acknowledgments

We acknowledge the help of Lisa Gravens-Muller from Data Coordinating Central Anel, Lauren C. Robinson from Le Bonheur Children's Hospital.

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Authors and Affiliations

  1. Division of Pediatric Nephrology and Hypertension, Children’s Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien Blvd, Detroit, MI, 48201, USA

    Tej K. Mattoo

  2. University of North Carolina, Chapel Hill, NC, USA

    Myra A. Carpenter

  3. National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA

    Marva Moxey-Mims

  4. Le Bonheur Children’s Hospital, Memphis, TN, USA

    Russell W. Chesney

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  1. Tej K. Mattoo
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  2. Myra A. Carpenter
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  3. Marva Moxey-Mims
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  4. Russell W. Chesney
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For The RIVUR Trial Investigators

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Correspondence to Tej K. Mattoo.

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Mattoo, T.K., Carpenter, M.A., Moxey-Mims, M. et al. The RIVUR trial: a factual interpretation of our data. Pediatr Nephrol 30, 707–712 (2015). https://doi.org/10.1007/s00467-014-3022-1

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  • DOI: https://doi.org/10.1007/s00467-014-3022-1

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