Improvement in vesicoureteral reflux grade on serial imaging predicts resolution

Area of Science:

• Pediatric Urology
• Nephrology
• Radiology

Background:

• Vesicoureteral reflux (VUR) is commonly diagnosed in children, often managed with antibiotic prophylaxis and serial imaging.
• The predictive value of changing reflux grade over time for eventual resolution remains unclear.

Purpose of the Study:

• To investigate whether improvement in vesicoureteral reflux grade on serial imaging predicts resolution in pediatric patients.
• To identify factors influencing reflux resolution in children.

Main Methods:

• Retrospective review of 1,761 children diagnosed with VUR, with 965 having at least 2 years of follow-up.
• Analysis of initial reflux grade and serial imaging grades up to 5 years post-diagnosis.
• Stratification by clinical characteristics to determine resolution status.

Main Results:

• Male gender, younger age at diagnosis (<1 year), lower initial reflux grade (I-III), and unilateral reflux were independent predictors of resolution.
• Reflux grade improvement on imaging at 1 year (HR 3.14) and improvement from the previous year at any point (HR 1.8) independently predicted resolution.

Conclusions:

• Male sex, younger age, lower initial grade, and unilateral reflux predict VUR resolution.
• Improvement in reflux grade on imaging, particularly within the first year, is a significant predictor of resolution.
• These findings support clinical counseling and therapeutic decision-making for pediatric VUR.