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Predictive factors of chronic kidney disease in severe vesicoureteral reflux

Jose Maria Penido Silva1, Jose Silverio Santos Diniz, Ana Cristina Simões Silva

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

Pediatric Nephrology (Berlin, Germany)
|June 23, 2006
PubMed

Insights

Children with severe bilateral primary vesicoureteral reflux (VUR) face a significant risk of chronic kidney disease (CKD). Key predictors include later diagnosis, higher VUR grade, and existing renal damage, though recent care offers protection.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Renal Medicine

Background:

  • Severe bilateral primary vesicoureteral reflux (VUR) in children is a significant risk factor for developing chronic kidney disease (CKD).
  • Understanding predictive factors for CKD in this population is crucial for early intervention and improved long-term renal outcomes.

Purpose of the Study:

  • To identify independent predictive factors for the development of chronic kidney disease (CKD) in pediatric patients diagnosed with severe bilateral primary vesicoureteral reflux (VUR).

Main Methods:

  • Retrospective cohort study involving 184 patients with VUR (grades III-V) diagnosed between 1970 and 2004.
  • Analysis of CKD risk using Kaplan-Meier method and Cox's regression model, with CKD defined as estimated glomerular filtration rate <75 ml/min/1.73 m².
  • Evaluation of independent predictors including age at diagnosis, VUR grade, renal damage, and admission decade.

Main Results:

  • The probability of CKD was estimated at 15% by 10 years post-VUR diagnosis.
  • Independent predictors of CKD included age at diagnosis >24 months (RR=4.8), VUR grade V (RR=3.5), and bilateral renal damage (RR=2.86).
  • Admission after 1990 was a protective factor (RR=0.16), and delayed VUR diagnosis (>12 months post-UTI) was also predictive (RR=2.2).

Conclusions:

  • Late diagnosis of VUR and higher VUR grades are significant risk factors for CKD in children.
  • While long-term prognosis for renal function remains concerning, advances in care, particularly after 1990, appear to offer a protective effect against CKD development.

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