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The Swedish reflux trial in children: IV. Renal damage

Per Brandström1, Tryggve Nevéus, Rune Sixt

  • 1Pediatric Uro-Nephrologic Center, The Queen Silvia Children's Hospital, University of Gothenburg, Göteborg, Sweden.

The Journal of Urology
|May 25, 2010
PubMed

Insights

Antibiotic prophylaxis is recommended for girls with dilating vesicoureteral reflux (VUR) to prevent new renal damage. Surveillance alone showed the highest rates of renal scarring in girls with VUR.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Infectious Diseases

Background:

  • Dilating vesicoureteral reflux (VUR) is a common condition in infants and young children.
  • VUR can lead to renal scarring and potential long-term kidney damage.
  • The optimal management strategy for VUR remains a subject of ongoing research.

Purpose of the Study:

  • To compare the incidence of new renal damage in children with dilating VUR.
  • To evaluate the effectiveness of antibiotic prophylaxis, endoscopic treatment, and surveillance.
  • To identify risk factors for renal damage in this population.

Main Methods:

  • A randomized controlled trial involving 203 children (1-2 years old) with grade III-IV VUR.
  • Participants were allocated to antibiotic prophylaxis, endoscopic treatment, or surveillance.
  • Renal damage was assessed using voiding cystourethrography and dimercaptosuccinic acid scintigraphy at baseline and 2-year follow-up.

Main Results:

  • New renal damage occurred in 15 children (13 girls, 2 boys).
  • Girls on surveillance had the highest rate of new renal damage (8 of 13).
  • New renal damage was significantly associated with recurrent febrile urinary tract infections (UTIs).

Conclusions:

  • Antibiotic prophylaxis appears to be effective in preventing new renal damage in girls with VUR.
  • Surveillance alone is associated with a higher risk of renal damage in girls.
  • Recurrent febrile UTIs are a significant risk factor for renal damage in girls with VUR.
Abstract

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