Evolution and prognosis value of intrarenal reflux

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.