Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults

Abstract

To ascertain the outcome of childhood vesicoureteric reflux (VUR), 226 adults (37 males), mean age 27 years, were studied after 10-35 years, extended to 41 years by postal questionnaire in 161. At presentation (mean age 5 years) all had VUR (grade III-V in 68) and urinary tract infection (UTI); there was renal scarring in 85 (acquired before referral in 11 and during follow-up in 1), hypertension in 6 and impaired renal function in 5. They were managed and followed prospectively by one paediatrician; 63% of these children remained free from UTI; VUR persisted in 63 and had resolved in 69% of 193 children managed medically. At follow-up, 61% of adults had remained free from infection; 17 adults had hypertension and/or raised plasma creatinine, 16 with scarred kidneys. Their deterioration was predictable because of scar type, blood pressure or plasma creatinine levels in childhood. No new scars developed after puberty. Renal growth rates were unaffected by initial severity or persistence of VUR. On the later questionnaire, 9 further adults, mean age 38 years, had moderate hypertension. The adults with complications were those with extensive renal scarring and/or at least borderline hypertension in childhood. Those with VUR, but no scarring, and managed carefully in childhood, did not suffer serious consequences as adults. There is a need for early recognition and treatment of children with VUR and UTI to limit scar development.

The Diagnosis of Urinary Tract infection in Young children (DUTY): a diagnostic prospective observational study to derive and validate a clinical algorithm for the diagnosis of urinary tract infection in children presenting to primary care with an acute illness

“…[38][39][40][41][42][43][44] Renal scarring has been associated with long-term complications including renal failure [end-stage renal failure (ESRF)], hypertension and pre-eclampsia. 2,[45][46][47] These are serious, chronic conditions responsible for significant morbidity and costs to the NHS. However, the evidence is weak and bias and/or confounding could be responsible for the observed associations.…”

“…However, the evidence is weak and bias and/or confounding could be responsible for the observed associations. 47 A recent paper estimated the risk of ESRF following childhood UTI to be 0.1% but the authors suggest that this could be an underestimate. 46 The NICE guideline concludes that 'there are no appropriate studies that accurately estimate the risks of long-term complications as a result of childhood UTI', highlighting the need for a long-term cohort study.…”

645 Sonographic Assessment of the Effect of Vesicoureteral Reflux and Urinary Tract Infections on Growth of the Pediatric Solitary Kidney

“…that in children with persistent VUR renal growth is likely to be normal if the kidneys are unscarred and there are no recurrent UTIs [2,3]. There are relatively few publications that touch on this process in children with solitary kidneys.…”

“…UTIs were tabulated by severity, where possible, and the grade of VUR was recorded based on the initial cystogram. Sonographically determined renal length was tabulated for all ultrasounds obtained The relationship between urinary tract infections (UTIs), renal scarring, and vesicoureteral reflux (VUR) has been investigated in multiple studies over numerous decades [1][2][3][4][5]. Even though renal failure secondary to the interaction of VUR and UTI is decidedly rare, the relationship is of interest.…”

Freqüência de desaparecimento do refluxo vésico-ureteral de graus I a III em pacientes pediátricos

“…11,14,15,[22][23][24][25] No período de 2 a 38 anos, desaparecimento do refluxo ocorreu em 15% a 80% de crianças ou adolescentes. 9,14,16,22,[24][25][26][27][28] Em nossa casuística a porcentagem de pacientes e do número de ureteres que apresentaram resolução do RVU foi semelhante ao descrito na literatura. 15,16,[25][26][27][28] Em crianças menores de cinco anos no início do…”