Clinical course of 735 children and adolescents with primary vesicoureteral reflux
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The purpose of this retrospective cohort study was to report the clinical course of children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR and were systematically followed in a single tertiary renal unit. Patients were followed up for a mean time of 76 months (6 months to 411 months). The events of interest were reflux resolution, renal damage, urinary tract infection (UTI), chronic kidney disease (CKD), and hypertension. Survival analysis was performed in order to evaluate reflux resolution and CKD. Renal damage was detected at admission in 319 patients (43.4%). Continuous low-dose antibiotic prophylaxis was administered to 624 patients (91.2%); 499 (73%) patients subsequently had no UTI or fewer than three episodes. The median time of persistence of reflux according to Kaplan–Meier analysis was 38 months for grade I/II [95% confidence interval (95% CI), 33–43], 98 months for grade III (95% CI, 78.5–105), and 156 months for grade IV/V (95% CI, 122–189). Twenty patients (3%) developed hypertension. It was estimated that the probability of CKD was 5% at 10 years after diagnosis of VUR; for children diagnosed after 1990 the probability of CKD was only 2%. Renal function impairment occurred in patients with severe bilateral reflux or in patients with contralateral renal hypoplasia. There has been an improvement of prognosis for patients diagnosed in the past 15 years.
KeywordsVesicoureteral reflux Reflux nephropathy Urinary tract infection Chronic renal failure Hypertension Prognosis
This study was partially supported by CNPq (Brazilian National Research Council) and Pró-Reitoria de Pesquisa (UFMG). M.A.V. was a recipient of the CNPq fellowship.
- 8.Smellie J, Edwards D, Hunter N, Normand IC, Prescod N (1975) Vesico-ureteric reflux and renal scarring. Kidney Int Suppl 4:S65–S72Google Scholar
- 9.Elder JS, Peters CA, Arant BS Jr, Ewalt DH, Hawtrey CE, Hurwitz RS, Parrott TS, Snyder HM 3rd, Weiss RA, Woolf SH, Hasselblad V (1997) Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children. J Urol 157:1846–1851PubMedGoogle Scholar
- 15.No authors listed (1987) Report of the second task force on blood pressure control in children - 1987. Task force on blood pressure control in children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 79:1–25Google Scholar
- 16.National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents (2004) The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114 Suppl 2:555–576Google Scholar
- 18.Weiss R, Tamminen-Mobius T, Koskimies O, Olbing H, Smellie JM, Hirche H, Lax-Gross H (1992) Characteristics at entry of children with severe primary vesicoureteral reflux recruited for a multicenter, international therapeutic trial comparing medical and surgical management. The International Reflux Study in Children. J Urol 148:1644–1649PubMedGoogle Scholar
- 29.No authors given (1983) Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux: two years’ observation in 96 children. Br Med J (Clin Res Ed) 287:171–174Google Scholar