The development of segmental scarring in previously normal kidneys seen in three children with vesicoureteric reflux

Tamminen, Tytti E.; Olbing, H; Bachmann, H

doi:10.1055/s-2008-1033793

Cited by 5 publications

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“…Focal parenchymal thinning whithout calyceal clubbing and without indentation of renal outline has been documented in children who have later developed SRS in respective areas (19).…”

Section: Different Types Ofmorphologie Renal Parenehymal Damagementioning

confidence: 99%

Comments on morphologic renal damage correlated with vesico-ureteral reflux

Olbing¹,

Tamminen²

1982

Klin Padiatr

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“…Focal parenchymal thinning whithout calyceal clubbing and without indentation of renal outline has been documented in children who have later developed SRS in respective areas (19).…”

Section: Different Types Ofmorphologie Renal Parenehymal Damagementioning

confidence: 99%

Comments on morphologic renal damage correlated with vesico-ureteral reflux

Olbing¹,

Tamminen²

1982

Klin Padiatr

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Vesico-uretero-renal reflux and the kidney

Olbing

1987

Pediatr Nephrol

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The most frequent complications of non-obstructive vesico-uretero-renal reflux (VUR) are segmental renal scars. These scars are confined to segments with intrarenal reflux which are, in addition, exposed to bacterial infection. Primarily, only gaping collecting duct orifices, confined to compound papillae and mainly situated at the kidney poles, allow intrarenal reflux. Scar contraction and obstruction seem to be able to transform closed collecting duct orifices into gaping ones, thereby enlarging the parenchymal area prone to intrarenal reflux and to renal scarring. Contrary to earlier reports, a recent survey has documented that new scars in children develop with significant frequency beyond 5 years of age. There is a greater tendency for scarring to develop with more severe VUR, but new renal scars can develop with all grades of VUR. Early and adequate antibiotic treatment decreases the extent of scarring. The results of experimental studies in which renal scarring developed in piglets with bladder decompensation resulting from intravesical obstruction but without bacterial infection may be relevant to the few children with proximal urethral valves and hypertonic neurogenic bladders but not to the large number with non-neurogenic detrusor instability or detrusor sphincter dyssynergia. Prospective studies have not shown different recurrence rates of urinary tract infections in medically managed compared with surgically managed children. The frequency of acute pyelonephritic attacks decreased significantly after operation.

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Five-year study of medical or surgical treatment in children with severe reflux: radiological renal findings

et al. 1992

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The renal findings on intravenous urography (IVU) are reported in 306 children (73 boys, 233 girls) from eight European centres entered into an international study comparing medical and surgical management of children with urinary tract infection and severe vesico-ureteric reflux followed for 5 years. One hundred and fifty-five children were randomly allocated to medical and 151 to surgical treatment. Protocol and investigative techniques were standardised and randomisation, data collection and analysis were performed centrally in Essen, Germany. At entry 149 (49%) has established renal scarring (79 medical, 70 surgical). Children with normal kidneys (105), areas of thinned parenchyma (52) and grade of reflux were also evenly distributed. IVU was repeated at 6, 18 and 54 months and serial urine culture, 99mtechnetium-dimercaptosuccinic acid scans and plasma creatinine estimations were performed. Two hundred and seventy-two children (89%) completed this follow-up. In 174 children (57%), (90 medical, 84 surgical) there was renal growth without morphological change. New renal scars developed in 19 children treated medically and 20 surgically; 12 (5 medical, 7 surgical) developed in previously normal kidneys. Six followed post-operative obstruction. No significant difference in outcome was found between medical or surgical management in terms of the development of new renal lesions or the progression of established renal scars.

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The development of segmental scarring in previously normal kidneys seen in three children with vesicoureteric reflux

Cited by 5 publications

References 0 publications

Comments on morphologic renal damage correlated with vesico-ureteral reflux

Comments on morphologic renal damage correlated with vesico-ureteral reflux

Vesico-uretero-renal reflux and the kidney

Five-year study of medical or surgical treatment in children with severe reflux: radiological renal findings

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