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The relationship between early renal status, and the resolution of vesico-ureteric reflux and bladder function at 16
M L Godley1, D Desai, C K Yeung
1The Institute of Child Health and Great Ormond Street Hospital for Children, NHS Trust, London UK. m.godley@ich.ucl.ac.uk
Insights
In infants with severe vesico-ureteric reflux (VUR), normal kidneys and bladder function at 16 months predict resolution. Bilateral renal abnormalities in boys indicate a poor prognosis for VUR and bladder function.
Area of Science:
- Pediatric Nephrology
- Urology
- Infant Health
Background:
- Vesico-ureteric reflux (VUR) is a common condition in infants.
- Early identification of renal abnormalities is crucial for predicting VUR outcomes.
- Bladder function assessment aids in understanding VUR resolution.
Purpose of the Study:
- To investigate the link between initial renal abnormalities and VUR/bladder function outcomes at 16 months in infants.
- To identify prognostic indicators for VUR resolution and bladder function in infants.
Main Methods:
- Studied 40 infants with VUR grade III or higher.
- Assessed initial renal abnormalities using renography/ultrasonography.
- Correlated findings with VUR outcome and bladder function at 16 months via cystography and urodynamics.
Main Results:
- Infants with normal kidneys showed VUR resolution and normal bladder function.
- Unilateral renal abnormalities correlated with partial VUR resolution and varied bladder function.
- Bilateral renal abnormalities in boys were associated with persistent VUR and abnormal bladder function.
Conclusions:
- Normal renal status and bladder function in infants predict successful VUR resolution.
- Bilateral renal abnormalities in male infants with severe VUR are poor prognostic indicators.
- Early renal and bladder assessment is vital for managing VUR in infants.
Objective:
To examine, in infants presenting with vesico-ureteric reflux (VUR), the relationship between the presence of initial renal abnormalities with the outcome of VUR and bladder function at 16 months of age.
Patients And Methods:
The study group comprised 40 infants (32 boys) presenting consecutively (29 after prenatal detection) with VUR grade III or greater (bilateral in 29) on the initial micturating cystogram (median age 8 weeks). The initial presence of abnormal kidneys was determined from isotopic renography and/or ultrasonography. These data were correlated with the outcome of VUR, from direct isotope cystography, and bladder function assessed by natural filling urodynamics, examined at age 16 months (mean 16.4 months, SD 2.1).
Results:
Three groups were identified. Group 1 (eight boys and six girls) had normal kidneys bilaterally; initially grade III VUR was common. At 16 months bladder function was normal in 10 children and none had VUR (complete resolution). Group 2 (14 boys and two girls) had unilateral renal abnormalities; initially VUR was predominantly grade IV or grade V. At 16 months bladder function was normal in eight children and VUR resolved in eight, five of these with normal bladder function. Group 3 (10 boys) had bilateral renal abnormalities. Initially grade V VUR predominated; at 16 months the bladder function was normal in only one, and in the rest the emptying dynamics were abnormal. All 10 boys had persisting VUR (no resolution).
Conclusions:
In infants with moderate or severe VUR, resolution at 16 months old is associated with normal kidneys in a similar proportion of boys and girls. Resolution also correlates well with normal bladder function. Presentation in infancy with bilateral abnormal kidneys, associated with severe VUR in boys, is a poor prognostic sign for the early outcome of VUR and for bladder function.