Primary vesicoureteral reflux: progress of disease, somatic growth and renal parameters

Area of Science:

• Pediatric Nephrology
• Urology
• Pediatric Surgery

Background:

• Primary vesicoureteral reflux (VUR) is a common condition in children.
• VUR can lead to urinary tract infections and renal scarring, potentially impacting long-term kidney function and growth.

Purpose of the Study:

• To prospectively evaluate renal function, scarring, and somatic growth in children with primary VUR.
• To assess the outcomes of medical management versus surgical intervention for different grades of VUR.

Main Methods:

• Prospective study of 30 children (1 day-12 yrs) with primary VUR.
• Periodic assessment of renal function, scarring, somatic growth, and reflux grade.
• Comparison of outcomes between medically managed and surgically treated groups.

Main Results:

• Complete resolution of grade I-III VUR with medical management observed in all units.
• 5 out of 27 units with grade IV-V VUR resolved with medical management.
• Significant improvement in height and weight gain noted in children with resolved reflux compared to those with persistent reflux.
• No deterioration in renal function or new scar formation observed in the overall cohort over 1-7 years.
• Children with persistent reflux on conservative management exhibited growth retardation, hypertension, and multiple renal scars.

Conclusions:

• Medical management is effective for lower-grade VUR and can lead to significant growth improvements.
• Higher-grade VUR may require surgical intervention, but medical management can still achieve resolution in some cases.
• Persistent VUR is associated with adverse outcomes, including growth retardation and renal damage, highlighting the importance of timely and effective management.