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Updated: Aug 4, 2026
A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction
Published on: December 20, 2014
Commentary: management of children with severe vesicoureteral reflux
1University College Hospital, London, England.
Insights
Medical versus surgical treatment for pediatric kidney scarring showed no significant differences in outcomes after five years. The study emphasizes preventing renal scarring to improve long-term prognosis in children.
Area of Science:
- Pediatric Nephrology
- Urology
- Clinical Trials
Background:
- Urinary tract infections (UTIs) in children can lead to renal scarring and potential long-term kidney damage.
- The International Reflux Study in Children (IRSC) aimed to compare medical and surgical management of vesicoureteral reflux (VUR).
- Vesicoureteral reflux is a condition where urine flows backward from the bladder to the kidneys, increasing UTI risk.
Purpose of the Study:
- To compare the long-term outcomes of medical versus surgical management for children with VUR and renal scarring.
- To evaluate the impact of treatment on renal growth, new scar formation, and progression of existing scars.
Main Methods:
- A randomized, stratified trial involving 434 children (128 from America, 306 from Europe) with VUR.
- Participants were allocated to either a medical or surgical treatment regimen.
- Follow-up included 5 years of observation with assessments of renal size, growth, and radiological scarring.
Main Results:
- No significant differences were observed between medical and surgical groups in renal size, growth, new scar development, or progression of established scarring after 5 years.
- While infection recurrence rates were similar, pyelonephritic symptoms were more frequent in the medically treated group.
- New renal scars developed in a similar proportion of children in both groups, including those with initially normal kidneys.
Conclusions:
- Neither medical nor surgical management demonstrated superiority in preventing further renal scarring or improving renal growth in the long term.
- The study highlights that renal scarring, not the persistence of reflux, is the primary determinant of prognosis.
- Emphasis should be placed on strategies for the prevention of renal scarring in children with VUR.
Abstract:
The main findings of the IRSC after 5 years of observation are summarized. Of the 434 children entered 128 were from centers in America and 306 from Europe. They were randomly allocated and stratified to a medical or surgical regimen. Of the children 50% had scarred kidneys at entry evenly distributed between the groups. After 5 years of observation there was no difference in outcome between the 2 treatment groups in terms of renal size and growth, the development of new radiological renal scars or areas of parenchymal thinning, or of progression of established scarring. In Europe infection recurred in equal numbers of children but pyelonephritic symptoms were more common in the medical group. Nevertheless, new scars developed in 19 of 155 children treated medically and 20 of 151 children treated surgically, including 5 and 7, respectively, with previously normal kidneys. Factors influencing the choice of treatment include patient age, availability of expert surgical care and experienced medical supervision, parental choice and compliance. Followup studies indicate that renal scarring rather than persistence of reflux determines the prognosis and, therefore, emphasis should be placed on the prevention of scarring.
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