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An Immature Murine Model of Reversible Unilateral Ureteral Obstruction
Published on: April 4, 2025
New renal scars in children with severe VUR: a 10-year study of randomized treatment
Hermann Olbing1, Jean M Smellie, Ulf Jodal
1Department of Pediatrics, University Children's Hospital, Essen, Germany.
Insights
Medical versus surgical management for severe vesicoureteral reflux (VUR) in children showed no significant difference in developing new kidney scars. Careful management minimizes new scar formation, particularly after five years.
Area of Science:
- Pediatric Nephrology
- Pediatric Urology
Background:
- Vesicoureteral reflux (VUR) in children can lead to urinary tract infections and kidney scarring.
- Management strategies include medical therapy and surgical intervention.
- Long-term outcomes regarding renal scarring are crucial for clinical decision-making.
Purpose of the Study:
- To prospectively compare the incidence of new radiological renal scars in children with grade III or IV VUR managed medically versus surgically.
- To evaluate the long-term development of renal scars following treatment for VUR.
Main Methods:
- Prospective randomized study of 306 children with grade III or IV VUR and symptomatic urinary tract infections.
- Children were randomized to either medical or surgical management.
- Radiological follow-up (urography) at 5 and 10 years to assess for new renal scars.
Main Results:
- New scars developed in 19/153 medically treated and 21/149 surgically treated children at 5 years.
- Only 2 additional new scars were observed between 5 and 10 years.
- New scars were more common in younger children (<5 years) and those with grade IV reflux, irrespective of treatment modality.
Conclusions:
- Careful management of severe VUR in children results in a low incidence of new renal scars.
- There is no significant difference in new scar formation between medical and surgical management of VUR.
- New scar development is infrequent after the initial 5-year follow-up period.
Abstract:
The International Reflux Study in Children was set up to compare prospectively the outcome of medical or surgical management of children with grade III or IV vesicoureteral reflux and a history of symptomatic urinary tract infection. Development of new radiological scars was the main end point. Of the 306 children randomized, 302 (153 medical, 149 surgical) were available for radiological follow-up at 5 years. New scars had developed in 19 medically and 21 surgically treated children. Among 223 patients (113 medical, 110 surgical) who continued follow-up with urography at 10 years, only 2 further new scars developed. Overall, 47 new scars were acquired in 42 patients (20 medical, 22 surgical), 25 of them in children with unscarred kidneys at entry (13 medical, 12 surgical). New scars occurred mostly in children under 5 years of age and were observed more frequently in children with grade IV than grade III reflux. We conclude that with careful management, only a small proportion of children with severe reflux developed new scars and rarely after the first 5-year follow up period, and that there was no difference between children treated medically or surgically.
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