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Contemporary incidence of morbidity related to vesicoureteral reflux
J P Vallee1, M P Vallee, S P Greenfield
1Department of Urology, Children's Kidney Center, Children's Hospital of Buffalo, New York 14222, USA.
Insights
Vesicoureteral reflux (VUR) screening and management have significantly reduced VUR-related morbidity in children. This comprehensive approach has altered the epidemiology of hypertension and renal failure, justifying its continued use.
Area of Science:
- Pediatric Nephrology
- Urology
- Public Health
Background:
- Vesicoureteral reflux (VUR) is linked to renal scarring and reflux nephropathy.
- Screening programs and management strategies for VUR have been implemented for over two decades.
- The effectiveness and necessity of these extensive VUR programs require evaluation.
Purpose of the Study:
- To assess the impact of a long-term VUR screening and management program on pediatric renal morbidity.
- To determine if VUR-related complications, such as hypertension and renal insufficiency, have decreased.
- To inform the continued use of these VUR intervention strategies.
Main Methods:
- Retrospective review of pediatric patients (1982-1997) at a regional nephrology referral center.
- Identification of patients with hypertension (HTN), renal insufficiency (RI), and end-stage renal disease (ESRD).
- Analysis of the prevalence of VUR as an underlying cause of these conditions.
Main Results:
- Vesicoureteral reflux (VUR) was the cause in only 5% of identified pediatric renal morbidity cases.
- Hypertension (HTN) was the most common comorbidity (57%), followed by end-stage renal disease (ESRD) (27%) and renal insufficiency (RI) (16%).
- Only one patient with VUR-related morbidity had a history of urinary tract infection (UTI), presenting early in the study period.
Conclusions:
- Increased awareness and treatment of VUR have led to a substantial decrease in VUR-related morbidity.
- The diagnosis and management of VUR have positively impacted the epidemiology of pediatric hypertension and renal failure.
- These findings support the continuation of comprehensive VUR screening and treatment programs.
Objectives:
The association among vesicoureteral reflux (VUR), renal scarring, and reflux nephropathy is well established. Screening programs for children who present with urinary tract infection (UTI) and their siblings, along with medical and surgical management, have been promoted by pediatric medical and urologic specialists in Buffalo and the surrounding community for more than two decades. Has this comprehensive and costly effort resulted in a decrease in VUR-related morbidity and should it be continued?
Methods:
The records of all active patients who presented from 1982 through 1997 to this region's single pediatric nephrology referral center were reviewed. One hundred twenty-two children and adolescents (73 boys, 49 girls) were identified with hypertension (HTN), renal insufficiency (RI), and end-stage renal disease (ESRD) requiring dialysis or transplantation.
Results:
There were 70 patients (57%) with HTN, 19 (16%) with RI, and 33 (27%) with ESRD. Reflux nephropathy was the underlying cause in 6 patients (5%)-3 with HTN and 3 with ESRD. The etiologies of morbidity in the remaining patients were medical renal disease, 61 (50%); idiopathic, 17 (14%); obstructive uropathy, 14 (11%); primary congenital renal hypoplasia, 12 (10%); and vascular, 12 (10%). Of the 6 patients with VUR-related morbidity, 4 were boys (3 with ESRD, 1 with HTN) and 2 were girls (with HTN). Five children presented in the 1980s and 1 in the 1990s. Only 1 patient had a history of UTI, and she presented early in the series in 1982 at 5 years of age. Ages of presentation were infancy (2 boys), early childhood (1 boy, 1 girl), and adolescence (1 boy, 1 girl). Reasons for presentation were failure to thrive (n = 2), voiding dysfunction without UTI (n = 1), muscle cramps (n = 1), UTI (n = 1), and HTN (n = 1). Reflux grade ranged from I to V, but 4 patients had grade III or less.
Conclusions:
Awareness of VUR-related morbidity has led to more widespread diagnosis and treatment, which appears to have resulted in a dramatic decrease in the numbers of affected patients in this community. The diagnosis and treatment of VUR has altered the epidemiology of HTN and renal failure in children and young adults.