A 14-year follow-up of conservative treatment for vesico-ureteric reflux

To determine renal function in patients with vesico-ureteric reflux (VUR) during 14 years of conservative treatment (no surgery).

Sixty patients with VUR were consecutively included between 1981 and 1982. The degree of VUR was determined by conventional voiding cysto-uretherography (VCUG) after 3 months of prophylactic antibiotics. The VUR was grade I-IV, with grades III and IV characterized as high-grade VUR. In all patients, any urinary tract infections and bladder-urethral dysfunction were treated. Renal function and reflux were monitored by renal and bladder scintigraphy using 123I-hippuran and the glomerular filtration rate (GFR) was determined using the plasma clearance of 51Cr-ethylaminediamine tetra-acetic acid.

Of the 60 patients who entered the study, 51 were followed for a mean of 13.7 years; nine patients were lost to follow-up. None of the patients underwent antireflux surgery. All patients were in good health and normotensive (except two with borderline hypertension). Of the 51 patients 21 had low-grade, 21 unilateral high-grade and nine bilateral high-grade reflux. In those with low-grade reflux both the mean renal split function on the most refluxing kidney and the GFR remained stable during the whole monitoring period. Eighteen patients who had a persistent reduction in renal split function or initially had had a significantly reduced functional share to the most refluxing kidney had their GFR re-assessed in adolescence. However, the body surface-corrected GFR remained constant. Total GFR and single kidney GFR increased significantly.

A conservative treatment regimen in patients with VUR can ensure stable kidney function, although kidneys with a lower renal function at referral seem to have an impaired functional growth potential.