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Clinical course of prenatally detected primary vesicoureteral reflux

José Maria Penido Silva1, Eduardo Araujo Oliveira, José Silvério Santos Diniz

  • 1Paediatric Nephrourology Unit, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, M.G., Brazil.

Pediatric Nephrology (Berlin, Germany)
|October 28, 2005
PubMed

Insights

Prenatally detected vesicoureteral reflux (VUR) in children generally follows a benign clinical course. Most cases show spontaneous resolution, especially mild reflux, with improved outcomes over time.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Diagnostic Imaging

Background:

  • Prenatal hydronephrosis is a common finding, often necessitating investigation for underlying conditions like vesicoureteral reflux (VUR).
  • Understanding the long-term clinical course of prenatally detected VUR is crucial for appropriate management and prognostication in pediatric patients.

Purpose of the Study:

  • To report the medium- to long-term clinical course and outcomes of children diagnosed with VUR detected prenatally.
  • To evaluate the spontaneous resolution rates and identify factors influencing the progression of VUR in this cohort.

Main Methods:

  • Retrospective analysis of 53 children with prenatally detected VUR followed for a mean of 66 months.
  • Initial diagnosis via ultrasound, voiding cystourethrogram (VCUG), and DMSA scan; follow-up included periodic VCUG or direct isotope cystogram.
  • Survival analysis and log-rank tests were used to assess reflux resolution and compare subgroups (mild vs. moderate/severe reflux).

Main Results:

  • 58% of infants had bilateral VUR, with 54% presenting severe reflux.
  • Renal damage was observed in 33.7% of renal units initially, significantly correlated with severe reflux (RR=3.4, p=0.002).
  • Spontaneous VUR resolution occurred in 45% of units; by 48 months, 75% of mild and 37% of severe reflux cases resolved. Urinary tract infections occurred in 25% of conservatively managed children.

Conclusions:

  • The clinical course of prenatally detected VUR is generally benign, with a significant rate of spontaneous resolution, particularly for milder forms.
  • Severe reflux is associated with a higher risk of renal scarring, underscoring the importance of early detection and monitoring.
  • The study highlights the heterogeneity of VUR and supports conservative management approaches for many cases, with improved nutritional parameters observed during follow-up.

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