Abstract
It is well known that the most serious complication of primary vesicoureteric reflux is chronic atrophic pyelonephritis or reflux nephropathy. The main goal in the management of vesicorenal reflux (VRR) is the prevention of progressive renal damage.
The elimination of reflux and the eradication of infection are fundamental in order to achieve this goal. The authors performed a retrospective study in 146 pediatric patients operated upon by ureteral reimplantation for primary VRR; 78 operations were unilateral and 68 bilateral, for a total of 214 reimplanted ureters. The mean age at the time of operation was 4.8 years; the mean age at the time of the study was 15.8 years, and the average postoperative observation period was 13.5 years.
The study included pre- and postoperative urine analysis and determinations of blood pressure, renal scarring and parenchymal growth, and evolution of renal function.
The study showed that: (1) urinary concentrating ability in bilateral high-degree VRR (64 patients) remained reduced in a relatively high percentage of patients; (2) there was significant improvement (from 40.7% to 17.9%) in proteinuria that was related to favorable evolution of renal function (z = 4.152; P <0.01); (3) the frequency of acute pyelonephritis decreased from 41.4 to 3.4%, and only 20% of the patients had episodes of afebrile pathologic bacteriuria in the postoperative period (z = 7.647; P <0.01); (4) more than 15% of the patients were hypertensive (10.3%) or at risk for hypertension, having a high peripheral plasma renin activity (5.2%); (5) some renal scarring developed despite successful antireflux surgery, and usually parenchymal growth resumed; in about 6% of the renal units a further decrease in renal size occurred; and (6) renal function generally improved after successful surgery (z = 4.115; P <0.01). This favorable evolution was much more evident in patients operated upon in the first 2–3 years of life (z = 3.885; P <0.01). However, when the renal function was already severely compromised, an antireflux operation had little or no effect on the inexorable decline in renal function.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ambrose SS, Parrott TS, Woodard JR, et al. (1980) Observations on the small kidney associated with vesicoureteral reflux. J Urol 123: 349–351
Bailey RR (1973) The relationship of vesicoureteric reflux to urinary tract infection and chronic pyelonephritis: reflux nephropathy. Clin Nephrol 1: 132–141
Beetz R, Schulte-Wissermann H, Troger J, et al (1989) Long-term follow-up of children with surgical treated vesicorenal reflux: postoperative incidence of urinary tract infections, renal scars and arterial hypertension. Eur Urol 16: 366–371
Belloli G, Bedogni L, Salano F, et al. (1985) Long-term evaluation of renal damage in primary vesico-renal reflux successfully operated on. Med Surg Pediatr 7: 643–652
Belloli G, Musi L, Biscuola G, et al. (1979) Primary vesico-renal reflux and pyelonephritis in infancy and childhood. Med Surg Pediatr 1: 89–98
Bhathena DB, Weiss JH, Holland NH et al. (1980) Focal and segmental glomerular sclerosis in reflux nephropathy. Am J Med 68: 886–890
Birmingham reflux study group (1983) Prospective trial of operative versus nonoperative treatment of severe vesicoureteric reflux. Br Med J 287: 171–174
Brenner BM, Meyer TW, Hostetter TH (1982) Dietary protein intake and the progressive nature of kidney disease. N Engl J Med 307: 652–659
Edwards D, Normand ICS, Prescod N (1977) Disappearance of vesicoureteric reflux during long-term prophylaxis of urinary tract infection in children. Br Med J 2: 285–288
Elo J, Tallgren LG, Alfthan O, et al. (1983) Character of urinary tract infections and pyelonephritic renal scarring after antireflux surgery. J Urol 129: 343–346
Filly R, Friediand GW, Govan DE, et al. (1974) Development and progression of clubbing and scarring in children with recurrent urinary tract infections. Radiology 113: 145–153
Hodson J (1978) Reflux nephropathy. Med Clin North Am 62: 1201–1221
Hodson J (1979) Reflux nephropathy: scoring the damage. In: Hodson J Kincaid-Smith P (eds) Reflux nephropathy. Masson, New York, pp 29–47
Holland NH, Kazee M, Duff D, et al. (1982) Antimicrobial prophylaxis in children with urinary tract infection and vesicoureteral reflux. Rev Infect Dis 4: 467–469
Holland NH, Kotchen T, Bhathena D (1975) Hypertension in children with chronic pyelonephritis. Kidney Int 8: S243-S251
Huland H, Buchardt P, Kollermann M, et al. (1979) Vesicoureteral reflux in end stage renal disease. J Urol 121: 10–12
Kincaid-Smith P (1979) Glomerular lesions in atrophic pyelonephritis. In: Hodson J, Kincaid-Smith P (eds) Reflux nephropathy. Masson, New York, pp 268–272
Lenaghan D, Whitaker JG, Jensen F, et al. (1976) The natural history of reflux and long-term effects of reflux on the kidney. J Urol 115: 728–730
Moffat DB (1979) Intrarenal reflux and the calycine fornices. In: Hodson J, Kincaid-Smiths P (eds) Reflux nephropathy. Masson, New York, pp 134–139
Neves RJ, Torres VE, Malek RS, et al. (1984) Vesicoureteral reflux in the adult. IV. Medical versus surgical management. J Urol 132: 882–885
Ransley PG, Ridson RA (1979) The renal papilla, intrarenal reflux, and chronic pyelonephritis. In: Hodson J, Kincaid-Smith P (eds) Reflux nephropathy. Masson, New York, 126–133
Report of the International Reflux Study Committee (1981) Medical versus surgical treatment of primary vesico-ureteral reflux. J Urol 125: 277–283
Rodriguez-Iturbe B (1990) The renal response to an acute protein load in man: clinical perspective. Nephro Dial Transplant 5: 1–9
Rolleston GL, Shannon FT, Utley WLF (1975) Follow-up of vesicoureteric reflux in the newborn. Kidney Int 8: S 59-S 64
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimate glomerular filtration rate in infants, children and adolescents. Pediatr Clin North Am 34: 571–590
Scott DJ et al. (1986) Function following surgica correction of vesico ureteric reflux in childhood. Br J Urol 58: 119–124
Smellie J, Edwards D, Hunter N, et al. (1975) Vesico-ureteric reflux and renal scarring. Kidney Int 8: S 65-S 72
Stanton AG (1988) Statistic per discipline bio-mediche. McGraw-Hill, Milano, pp 91–123
Steinhardt GF (1985) Reflux nephropathy. J Urol 134: 855–859
Task force on blood pressure control in children (1987) Report of the second task force on blood pressure control in children. Pediatrics 79: 1–25
Wallace DMA, Rothwell DL, Williams DI (1978) The long-term follow-up of surgically treated vesicoureteric reflux. Br J Urol 50: 479–484
Weston PMT, Stone AR, Bary PR et al. (1982) Results of reflux prevention in adults with reflux nephropathy. Br J Urol 54: 677–681
Willscher MK, Bauer SB, Zammuto PJ, et al. (1976) Renal growth and urinary infection following antireflux surgery in infants and children. J Urol 115: 722–725
Author information
Authors and Affiliations
Additional information
Correspondence to: G. Belloli
Rights and permissions
About this article
Cite this article
Belloli, G., Bolla, G., Cappellari, F. et al. Long-term follow up of surgically treated primary vesicorenal reflux. Pediatr Surg Int 9, 76–81 (1994). https://doi.org/10.1007/BF00176117
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00176117