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Evolution and prognosis value of intrarenal reflux

J Boubnova1, A Sergent-Alaoui, G Deschênes

  • 1Armand-Trousseau Children's Hospital, Pediatric Surgery Department, 26, av. du Dr Arnold Netter, 75012 Paris, France. julia.boubnova@gmail.com

Journal of Pediatric Urology
|October 19, 2010
PubMed

Insights

Intrarenal reflux (IRR) in children with urinary tract infections (UTIs) shows a similar prognosis to high-grade vesicoureteral reflux (VUR) without IRR. Aggressive management is not indicated for IRR based on this 3-year follow-up study.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Infectious Diseases

Background:

  • Intrarenal reflux (IRR) is a subtype of vesicoureteral reflux (VUR).
  • The prognostic significance of IRR in pediatric urinary tract infections (UTIs) requires further clarification.
  • Understanding IRR's impact on renal scarring and UTI recurrence is crucial for management decisions.

Purpose of the Study:

  • To evaluate the prognostic significance of IRR.
  • To assess the association of IRR with UTIs, renal scarring, and spontaneous reflux resolution.
  • To compare outcomes of IRR with high-grade VUR without IRR over 3 years.

Main Methods:

  • A cohort study comparing 33 patients with IRR to 27 controls with high-grade VUR without IRR.
  • Patients received antibiotic prophylaxis; surgery was reserved for recurrent UTIs.
  • Renal scarring was assessed using DMSA scans at baseline, 18, and 36 months.

Main Results:

  • Initial DMSA scans revealed more moderate/severe renal damage in the IRR group (P < 0.03).
  • Over 3 years, UTI incidence, reflux resolution, and DMSA scan stability were similar between groups.
  • Surgical intervention rates were comparable between the IRR and control groups.

Conclusions:

  • Under medical management, IRR has a comparable prognosis to high-grade VUR without IRR.
  • The presence of IRR does not necessitate more aggressive treatment than high-grade VUR.
  • Conservative management appears appropriate for pediatric patients with IRR.
Abstract

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