Clinical course of 735 children and adolescents with primary vesicoureteral reflux

Abstract

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.

Alt üriner sistem işlev bozukluğu bulunan çocuklarda ürodinami ve ultrasonografi bulgularının karşılaştırılması

“…However, secondary VUR which is observed less commonly develops secondary to increased intra-bladder pressure due to anatomical, neurological or idiopathic causes (8). In the study performed by Silva et al (9), lower urinary system dysfunction was found in 114 of 671 patients (17%) with VUR. Vesicoureteral reflux is observed in approximately 20-50% of children with lower urinary system dysfunction (10).…”

“…Lower urinary system dysfunction not treated successfully has been reported to be one of the most important causes of recurring urinary tract infection (5-7). The relation of lower urinary system dysfunction and vesicouretheral reflux (VUR) has been studied in many studies (8)(9)(10)(11). Primary VUR is the most common form and is caused by proceeding of distal ureters in a short mucosal tunnel.…”

Frequency of Hypertension with Ambulatory Blood Pressure Monitoring in Children with Renal Damage

“…The presence of hypertension is strongly associated with renal damage (11) . In one study, 21% of the children with newly diagnosed hypertension had hypertension etiology showing renal scarring (12) .…”

The prevalence of hypertension and cardiovascular risks in children with renal scars secondary to urinary tract infection

“…The prevalence of renal scars in hypertensive children is 21% (2). Longitudinal studies estimate 3% to 30% increment of the occurrence of hypertension after longtime follow up of patients with a history of parenchymal scarring secondary to vesicoureteral refl ux (VUR) and UTI during childhood (3)(4)(5). These studies are based on conventional blood pressure measurements.…”