Background We assessed the impact of anorectal malformation (ARM) on the kidneys of children with dilating vesicoureteral reflux (D-VUR) ≥grade III using a simple dimercaptosuccinic acid (DMSA) scintigraphy scan based renal dysfunction score (RDS). Methods The medical records of 121 patients with D-VUR treated between 2000 and 2014 were reviewed retrospectively. After excluding patients with secondary D-VUR (n=18), presence of ARM was used to create two groups: ARM+ (n=12 cases; 15 ureters) and ARM– (n=91 cases; 131 ureters). Types of ARM, grades of D-VUR, bladder and bowel dysfunction (BBD) and RDS were compared. Results Patient demographics, mean follow-up, grades of D-VUR and history of urinary tract infections were not significantly different. BBD was significantly higher in ARM+ (41.7% versus 7.7%, p=0.0006). RDS was significantly higher in ARM+ (p=0.036). Grades of D-VUR were significantly lower in ARM– with low RDS (p=0.008). During follow-up, changes in DMSA uptake over time were not observed in ARM+. Conclusions While renal cortical lesions were correlated with grade of D-VUR in ARM– and RDS was significantly higher in ARM+, BBD did not appear to contribute to progressive renal dysfunction as is commonly believed. In fact, no progression in renal cortical lesions was observed in ARM+ based on RDS data. Renal cortical lesions may possibly be a feature of ARM, a topic that warrants further study.

中文翻译：

---

扩张型膀胱输尿管反流伴肛门直肠畸形患者的肾脏结构和功能

背景 我们使用简单的二巯基丁二酸 (DMSA) 闪烁扫描肾功能障碍评分 (RDS) 评估了肛门直肠畸形 (ARM) 对扩张性膀胱输尿管反流 (D-VUR) ≥ III 级儿童肾脏的影响。方法回顾性回顾2000年至2014年收治的121例D-VUR患者病历。在排除继发性 D-VUR (n=18) 患者后，ARM 的存在被用于创建两组：ARM+（n=12 例；15 个输尿管）和 ARM-（n=91 例；131 个输尿管）。比较了 ARM 的类型、D-VUR 的等级、膀胱和肠功能障碍 (BBD) 和 RDS。结果 患者人口统计学、平均随访、D-VUR 分级和尿路感染史无显着差异。BBD 在 ARM+ 中显着更高（41.7% 对 7.7%，p=0.0006）。RDS 在 ARM+ 中显着更高 (p=0.036)。D-VUR 的等级在 ARM 中显着降低，RDS 较低 (p=0.008)。在随访期间，在 ARM+ 中未观察到 DMSA 摄取随时间的变化。结论 虽然肾皮质病变与 ARM- 中的 D-VUR 等级相关，而 ARM+ 中的 RDS 显着更高，但 BBD 似乎不像通常认为的那样导致进行性肾功能障碍。事实上，根据 RDS 数据，在 ARM+ 中没有观察到肾皮质病变的进展。肾皮质病变可能是 ARM 的特征，值得进一步研究。结论 虽然肾皮质病变与 ARM- 中的 D-VUR 等级相关，而 ARM+ 中的 RDS 显着更高，但 BBD 似乎不像通常认为的那样导致进行性肾功能障碍。事实上，根据 RDS 数据，在 ARM+ 中没有观察到肾皮质病变的进展。肾皮质病变可能是 ARM 的特征，值得进一步研究。结论 虽然肾皮质病变与 ARM- 中的 D-VUR 等级相关，而 ARM+ 中的 RDS 显着更高，但 BBD 似乎不像通常认为的那样导致进行性肾功能障碍。事实上，根据 RDS 数据，在 ARM+ 中没有观察到肾皮质病变的进展。肾皮质病变可能是 ARM 的特征，值得进一步研究。