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Right arrow Genitourinary Tract

PEDIATRICS Vol. 105 No. 4 April 2000, pp. 800-804

Sibling Vesicoureteral Reflux in Multiple Gestation Births

Received Feb 4, 1999; accepted Jul 12, 1999.

Martin Kaefer*, Michael CurranDagger , S. Ted Treves§, Stuart Bauer*, W. Hardy Hendrenparallel , Craig A. Peters*, Anthony Atala*, David Diamond*, and Alan Retik*

From the * Department of Urology, Children's Hospital and Harvard Medical School, Boston, Massachusetts; Dagger  Department of Urology, Lahey Clinic, Burlington, Massachusetts; and § Division of Nuclear Medicine and parallel  Department of Surgery, Children's Hospital and Harvard Medical School, Boston, Massachusetts.

Background.  Vesicoureteral reflux (VUR) is the most commonly inherited disease of the genitourinary tract. Although the majority of evidence supports a genetic cause, the tendency for this condition to spontaneously improve over time has made it difficult to determine the actual mode of transmission. We report the incidence of VUR in siblings of multiple gestation births and for the first time compare the relative incidence of reflux between identical and fraternal twins.

Methods.  A database consisting of all radionuclide cystograms and voiding cystourethrograms performed between the years 1986 and 1996 was searched for multiple gestation births. The medical records of each patient were evaluated for age at presentation, zygosity, reflux grade, and time to resolution. Children with secondary causes of VUR (eg, posterior urethral valves) were excluded. Triplets were treated as 2 pairs of twins for statistical analysis.

Results.  Forty-six pairs met the inclusion criteria (31 dizygotic and 15 monozygotic). Overall, 23 (50%) of 46 siblings of index cases had demonstrable VUR. Comparison of VUR prevalence between identical and nonidentical twins was revealing with 80% (12/15) of identical twins and 35% (11/31) of fraternal twins having VUR. When only the youngest individuals in each group were considered, 100% (7/7) of the monozygotics and 50% (5/10) of the dizygotics demonstrated this trait.

Conclusions.  High concordance for VUR in identical twin siblings supports a genetic basis for the transmission of this disease. Results obtained from fraternal twin siblings provides convincing evidence that this trait is transmitted in an autosomal dominant fashion.  Key words:  vesicoureteral reflux, sibling reflux, autosomal dominant.




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