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Followup of conservatively treated children with high and low grade vesicoureteral reflux: a prospective study
1Centro de Nefrologia Infantil de Porto Alegre, Hospital de Clinicas de Porto Alegre, Brazil.
Insights
Vesicoureteral reflux (VUR) is diagnosed earlier in boys. While VUR may last longer in boys, this difference isn't significant. Stratifying by sex and VUR grade is crucial for understanding its natural history.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Management of Reflux
Background:
- Vesicoureteral reflux (VUR) is a condition often identified after urinary tract infections in children.
- Early diagnosis and understanding the natural history of VUR are crucial for effective management.
- Reflux nephropathy and breakthrough infections are significant concerns in pediatric VUR cases.
Purpose of the Study:
- To investigate the natural history of medically managed vesicoureteral reflux in children.
- To analyze the impact of sex and reflux grade on VUR diagnosis, nephropathy, and outcomes.
- To determine factors influencing the spontaneous resolution of VUR.
Main Methods:
- Prospective study of 202 children diagnosed with VUR.
- Data collection included age at diagnosis, reflux grade, dimercaptosuccinic acid scans for reflux nephropathy, and breakthrough urinary tract infections.
- Life table estimations were used to analyze the duration of VUR, stratified by sex and reflux grade.
Main Results:
- VUR diagnosis occurred significantly earlier in boys than girls (p < 0.001).
- Reflux nephropathy was present in 44% of kidneys at entry, with more severe lesions in boys (p < 0.05).
- Breakthrough infections were more common in girls (p < 0.05), but new scars did not differ significantly between sexes.
Conclusions:
- Children with VUR should be stratified by sex and reflux grade to understand its natural history.
- While VUR may resolve slightly later in boys, the difference is not statistically significant.
- Effective management requires considering sex-specific differences in VUR presentation and outcomes.
Abstract:
A total of 202 children (mean age 31.5 +/- 23.3 months) with vesicoureteral reflux identified during the investigation that follows a urinary tract infection entered this prospective study dealing with the medical management of reflux. The diagnosis of vesicoureteral reflux was made significantly earlier in boys than in girls regardless of reflux grade (p < 0.001). At entry reflux nephropathy was present on a dimercaptosuccinic acid scan in 44% of 314 refluxing kidneys. There was no significant difference between boys and girls in the prevalence of reflux nephropathy. The renal lesions were more severe in boys independently of the grade of vesicoureteral reflux (p < 0.05). Breakthrough urinary tract infection was significantly more common in girls than in boys, regardless of vesicoureteral reflux grade (p < 0.05). Mean followup was 68.7 +/- 31.2 months. Patient age at the time of the first of 2 radionuclide cystograms without vesicoureteral reflux was considered the age of spontaneous resolution of reflux. Using life table estimations and analyzing data stratified to sex and grade of vesicoureteral reflux, we found that although reflux lasted longer in boys compared to girls, this difference was not statistically significant. During followup new scars developed in 7 patients related to breakthrough urinary tract infection. There was no significant difference between boys and girls in the development of new scars. To understand the natural history of vesicoureteral reflux children must be stratified by sex and grade of reflux.