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Long-term followup of infants with gross vesicoureteral reflux
R R Bailey1, K L Lynn, A H Smith
1Department of Nephrology, Christchurch Hospital, New Zealand.
Insights
Infants with severe vesicoureteral reflux often have kidney damage. Long-term follow-up shows good outcomes for those without severe bilateral reflux nephropathy at presentation.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Follow-up Studies
Background:
- Vesicoureteral reflux (VUR) in infants frequently leads to renal damage.
- Early detection and management of VUR are critical for preventing long-term renal complications.
Purpose of the Study:
- To report the long-term outcomes of infants diagnosed with gross vesicoureteral reflux.
- To assess the development and progression of reflux nephropathy in this cohort.
Main Methods:
- Longitudinal follow-up of 31 infants presenting with gross VUR between 1952 and 1970.
- Assessment of renal damage, proteinuria, hypertension, and renal function over decades.
Main Results:
- Of 21 patients followed for 16-37 years, 4 had normal kidneys, 13 had unilateral, and 4 had bilateral reflux nephropathy.
- Patients with unilateral reflux nephropathy showed risks of proteinuria, hypertension, and renal failure, especially those with a single kidney.
- Bilateral reflux nephropathy was associated with proteinuria and renal insufficiency, with one patient progressing to end-stage renal failure.
Conclusions:
- Infants with gross VUR can achieve good long-term outcomes if they do not present with severe bilateral reflux nephropathy.
- Regular nephrological supervision is essential for patients with reflux nephropathy, monitoring proteinuria, renal function, and blood pressure.
Abstract:
The majority of children (1 year old or less) with gross vesicoureteral reflux already have renal damage at the time of presentation or reflux nephropathy develops during the first few years of life. We report the long-term followup of 31 patients (16 boys) presenting in infancy with gross vesicoureteral reflux (Rolleston classification) between 1952 and 1970. They had a total of 44 grossly refluxing ureters (13 bilateral, 18 unilateral) and presented between ages 1 day and 48 weeks (mean 15.3 weeks). Of the 31 infants 5 died within the first year of life, 4 were followed for up to 11 years before being lost to followup and 1 was killed in a motor vehicle accident after 19.5 years of followup. The remaining 21 patients have been followed for 16 to 37 years (mean 23.9 years); 4 have normal kidneys, and 13 have unilateral and 4 have bilateral reflux nephropathy. Of those patients with unilateral reflux nephropathy proteinuria, hypertension and renal failure developed in 1 born with a single kidney and he is now on hemodialysis, while 2 others have a diastolic blood pressure of 90 mm. Hg or greater. Of the 4 patients with bilateral reflux nephropathy 2 have proteinuria and renal insufficiency, with 1 progressing towards end stage renal failure. Infants who present with gross vesicoureteral reflux within the first year of life appear to do well if free of severe bilateral reflux nephropathy at presentation. Patients with reflux nephropathy should remain under regular nephrological supervision with particular attention given to proteinuria, renal function and blood pressure.