Related Experiment Video
Updated: Jul 31, 2026
A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction
Published on: December 20, 2014
Split renal function does not change after successful treatment in children with primary vesico-ureteric reflux
F Matsumoto1, K Shimada, Y Harada
1Department of Urology, Osaka Medical Centre and Research Institute for Maternal and Child Health, Osaka, Japan. fumim@mch.pref.osaka.jp
Insights
In children with primary vesico-ureteric reflux (VUR), split renal function remains stable with strict urinary tract infection (UTI) control. This indicates no significant kidney growth changes or deterioration, even with reflux nephropathy.
Area of Science:
- Pediatric Nephrology
- Nuclear Medicine
- Urology
Background:
- Primary vesico-ureteric reflux (VUR) is a common condition in children, potentially leading to kidney damage.
- Assessing renal growth patterns and split renal function is crucial for managing VUR and preventing long-term complications.
- 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy is a key imaging modality for evaluating renal function in pediatric VUR.
Purpose of the Study:
- To evaluate the long-term renal growth pattern in children diagnosed with primary VUR.
- To assess changes in split renal function using serial 99mTc-DMSA scintigraphy over a decade.
- To determine the impact of treatment (surgical vs. conservative) on renal function in pediatric VUR patients.
Main Methods:
- A cohort of 712 children (<16 years) with primary VUR underwent voiding cysto-urethrography for diagnosis.
- Patients were treated surgically or conservatively and followed with serial 99mTc-DMSA scintigraphy for up to 10 years.
- Split renal function was measured using relative uptake (RU) of 99mTc-DMSA, with initial scans performed at least 4 weeks post-febrile UTI.
Main Results:
- Initial relative uptake (RU) of the right kidney showed a strong correlation with repeated scans in both surgical and conservative groups (R=0.99 and R=0.94-0.97, respectively).
- The change in RU remained minimal (within 0.05) across all patients following treatment.
- No febrile urinary tract infections (UTIs) recurred after initial post-operative UTI in the surgically treated group.
Conclusions:
- Under strict urinary tract infection (UTI) control, split renal function in children with primary VUR remains stable over time.
- There is no evidence of accelerated or compensatory kidney growth in the presence of reflux nephropathy.
- The study suggests no significant deterioration or atrophy of renal function in children with VUR when UTIs are managed effectively.
Objective:
To evaluate the renal growth pattern in patients with primary vesico-ureteric reflux (VUR) using long-term measurements of split renal function with 99mTc-dimercaptosuccinic acid (DMSA) scintigraphy.
Patients And Methods:
In all, 712 children aged < 16 years (466 boys and 246 girls) with primary VUR were referred to our hospital from July 1991 to December 2000. VUR was diagnosed by voiding cysto-urethrography. The patients were treated either surgically (group 1) or conservatively (group 2) and followed with serial 99mTc-DMSA scintigraphy for up to 10 years. There were 942 examinations in 367 of 712 patients who had repeat scintigraphy. Patients with secondary VUR, VUR to a solitary or fused kidney, or upper urinary tract obstruction, were excluded. Five of 298 patients (1.7%) who had ureteric reimplantation had a febrile urinary tract infection (UTI) soon after surgery but none recurred (recurrence is an indication for surgery in children with VUR); there was no febrile UTI in the 69 patients in group 2. Planar scintigraphy with 99mTc-DMSA was used to assess the absolute uptake (AU) of each kidney, measured as a percentage of the injected dose, and the relative uptake (RU = AU of each kidney/AU of both kidneys) calculated. The initial examination was at least 4 weeks after any febrile UTI in most patients. Serial studies were conducted 1 year after surgery and then biannually in group 1. In group 2 the DMSA scan was repeated every 2-3 years. The change in split renal function was compared with the RU of the right kidney.
Results:
The RU of the right kidney at the initial scan correlated closely with those on repeated scans in both groups. The correlation coefficients were 0.99 in group 1 and 0.94-0.97 in group 2 at every study. The change of RU remained within 0.05 in all patients after treatment.
Conclusions:
Under strict control of UTI, split renal function in children with primary VUR does not change. There may be no possibility of accelerated or compensatory growth of the kidney with reflux nephropathy, but no concern about deterioration and atrophy either.
Related Concept Videos
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:29Acute Kidney Injury III: Clinical Manifestations
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care