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[Drug therapy of vesico-ureteral reflux in children]
V Nikolić1, R Bogdanović, A Cvorić
1Mother and Child Health Institute of Serbia.
Insights
Medical management successfully treated most childhood primary vesicoureteric reflux (VUR). Continuous antibiotic prophylaxis and VUR grade influenced outcomes, with lower grades resolving more often. Long-term renal function was generally preserved.
Area of Science:
- Pediatric Urology
- Nephrology
- Infectious Diseases
Context:
- Primary vesicoureteric reflux (VUR) is a common condition in children.
- Medical management with continuous chemoprophylaxis is a standard treatment approach.
- Long-term outcomes and renal function preservation are key concerns.
Purpose:
- To evaluate the efficacy of medical management for primary VUR in children.
- To identify factors influencing spontaneous resolution and long-term renal outcomes.
- To assess the role of chemoprophylaxis in managing VUR.
Summary:
- A study of 138 children with primary VUR managed medically showed spontaneous resolution in 66% over 2-6 years.
- Vesicoureteric reflux (VUR) grade at presentation was the most significant factor predicting resolution.
- While renal scarring and recurrent infections did not affect cure rates, they prolonged resolution time and increased chronic renal failure risk in one case.
Impact:
- Medical management is effective for most childhood VUR cases, preserving renal function.
- Understanding prognostic factors like VUR grade aids in tailoring treatment strategies.
- This study supports the long-term benefits of conservative management for VUR in pediatric patients.
Abstract:
The results of medical management of primary vesicoureteric refluc in 138 children aged 3 months to 15 years are presented. All children were kept on long-term, low-dose continuous chemoprophylaxis of urinary tract infection. During the 2-6 years follow-up period serial urine cultures, interval radiographic revaluation, renal function tests and blood pressure measurements were performed. Refluc disappeared spontaneously in 91 patients (66%), persisted in 9.4% and was later on surgically corrected in 20% of children. The refluc grade at presentation was the most important factor affecting the outcome: the refluc disappeared from 72% of affected ureters with grade I and II, and from 28% of ureters with grade III and IV. The presence of renal scaring and recurrence of urinary tract infection during the chemophylaxis did not influence the percentage of cured patients. Nevertheless, the mean duration of refluc from diagnosis to its spontaneous resolution was significantly longer in children with renal scars and urinary tract infections compared with its duration in children who had neither scars, nor further infections. Renal scarring progressed in 2.8% patients. Chronic renal failure developed, in spite of spontaneous resolution of refluc, in only one child with hypertension and bilateral renal scars at presentation. It is concluded that medical treatment of vesicoureteric refluc in most of the children is successful and in regard of preserving renal function stage.