Published online November 18, 2008
PEDIATRICS Vol. 122 Supplement December 2008, pp. S233-S239 (doi:10.1542/peds.2008-1285c)

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SUPPLEMENT ARTICLE

Randomized Intervention for Children With Vesicoureteral Reflux (RIVUR): Background Commentary of RIVUR Investigators

Russell W. Chesney, MD^a, Myra A. Carpenter, PhD^b, Marva Moxey-Mims, MD^c, Leroy Nyberg, MD^c, Saul P. Greenfield, MD^d, Alejandro Hoberman, MD, MPH^e, Ron Keren, MD, MPH^f, Ron Matthews, MD^g, Tej K. Matoo, MD^h members of the RIVUR Steering Committee

^a Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee
^b Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
^c National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
^d Department of Pediatric Urology, Children's Hospital, Buffalo, New York
^e Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
^f Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^g Department of Urology, Johns Hopkins University, Baltimore, Maryland
^h Department of Pediatrics, Children's Hospital of Michigan, Detroit, Michigan

Because of the frequency of urinary tract infections in children, off-label use of antimicrobial prophylaxis is often the usual treatment of children with vesicoureteral reflux, and such use is increasingly being called into question; hence, a definitive study to determine the value of antimicrobial prophylaxis with regard to the recurrence of urinary tract infection and the incidence of renal scarring is essential. The currently recommended follow-up procedures (repeated urine cultures, renal and genitourinary imaging, antimicrobial therapy and prophylaxis, as well as other factors including cleanliness, adequate bladder and bowel emptying, and compliance with protocols) are expensive (in terms of time, attention to detail, and cost) and cumbersome. Such recommendations should be evidence-based.

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Key Words: clinical research/trials • urinary tract infections • vesicoureteric reflux • VUR

Abbreviations: UTI—urinary tract infection • VUR—vesicoureteral reflux • ESRD—end-stage renal disease • DES—dysfunctional elimination syndrome • DMSA—dimercaptosuccinic acid • APN—acute pyelonephritis

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Accepted Jun 6, 2008.

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