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Longitudinal development of renal damage and renal function in infants with high grade vesicoureteral reflux
Sofia Sjöström1, Ulf Jodal, Rune Sixt
1Department of Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. sofia.sjostrom@vgregion.se
Insights
High-grade vesicoureteral reflux in infants frequently causes renal abnormalities and subnormal kidney function. Infection control is key to preventing deterioration in renal status over time.
Area of Science:
- Pediatric Nephrology
- Urology
- Diagnostic Imaging
Background:
- High-grade vesicoureteral reflux (VUR) is a significant risk factor for renal damage in infants.
- Early detection and monitoring are crucial for managing potential long-term renal complications.
Purpose of the Study:
- To investigate the progression of renal abnormality and function in infants diagnosed with high-grade VUR.
- To identify factors associated with renal status changes over time.
Main Methods:
- Prospective observational study of 115 infants (<1 year) with grade III-V VUR.
- Follow-up included renal scintigraphy, 51chromium edetic acid clearance, and video cystometry over a median of 62 months.
- Diagnosis was established prenatally or post-urinary tract infection.
Main Results:
- Renal abnormality was present in 90% of infants at follow-up, frequently bilateral.
- 30% of patients had reduced total glomerular filtration rate (<80% expected).
- Renal status remained stable in 78%, improved in 5%, and deteriorated in 18%; recurrent infections and bilateral abnormalities predicted deterioration.
Conclusions:
- Infants with high-grade VUR commonly exhibit renal abnormalities and impaired kidney function.
- While overall deterioration is infrequent, infection control is vital for preserving renal status.
- Subnormal kidney function and structural changes necessitate long-term monitoring.
Purpose:
We sought to study renal abnormality and renal function through time in infants with high grade vesicoureteral reflux.
Materials And Methods:
This prospective observational study included 115 infants (80 boys and 35 girls) younger than 1 year with grade III to V vesicoureteral reflux. The diagnosis was made after prenatal ultrasound in 26% of the patients and after urinary tract infection in 71%. Patients were followed by renal scintigraphy, 51chromium edetic acid clearance and video cystometry. Median followup was 62 months.
Results:
Renal abnormality, which was found in 90% of the children at followup, was generalized in 71% and focal in 29%. The abnormality was bilateral in 28% of the affected patients. Total glomerular filtration rate was less than 80% of expected in 30% of the patients. Single kidney function was less than 40% of expected total glomerular filtration rate in 71% of the patients. Renal status (parenchymal abnormality and function) remained unchanged through time in 84 of 108 available cases (78%), improved in 5 (5%) and deteriorated in 19 (18%). Predictive factors for deterioration were recurrent febrile urinary tract infection, bilateral abnormality and reduced total glomerular filtration rate. Deteriorated renal status was more common in cases diagnosed prenatally than in those detected after urinary tract infection.
Conclusions:
Among these infants with high grade vesicoureteral reflux renal abnormality was frequent and was associated with subnormal filtration of one of the kidneys. Decreased total glomerular filtration rate was seen in about a third of the patients. Overall deterioration of renal status was seen in only a fifth of the patients. Infection control seems to be an important factor to minimize the risk.
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