Vesicoureteric reflux and renal scarring in children--a local perspective

This study was undertaken to determine the extent of primary vesicoureteric reflux and renal scarring in patients investigated for urinary tract infection in the Singapore General Hospital between 1983 and 1988. The clinical profile of patients and possible clinical features associated with renal scarring were analysed. These findings serve as a useful guide in the investigation and management of VUR in our population. The incidence of vesicoureteric reflux among patients investigated for documented urinary tract infection was high at 32.9%. The mean age at presentation was 15.2 months. Almost all patients were less than five years-old. A male predominance was noted in affected infants. High grade refluxes of Grade IV or more (International Reflux Study Classification) were found in 45.7/patients and were associated with a higher incidence of recurrent urinary tract infection (p less than 0.05). Thirty-four 99mTc-dimercaptosuccinic acid scans were done and 46.4% of refluxing kidneys showed renal scars. The incidence of renal scarring was significantly higher in patients presenting at an early age (less than 2 years), in high grade reflux and in recurrent urinary tract infection (p less than 0.05; p less than 0.01 and p less than 0.001 respectively). Therefore all children with documented urinary tract infection who are less than five years old and especially male infants should be fully investigated for early detection and treatment of vesicoureteric reflux and renal scars. Kidneys with vesicoureteric reflux at risk of scarring appeared to be those with early presentation, high grade reflux and recurrent urinary tract infection whose management should therefore be vigorous.