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Vesico-ureteric reflux in Down's syndrome: poor prognosis
1Department of Surgery, Adelaide Children's Hospital, South Australia.
The Australian and New Zealand Journal of Surgery
|February 1, 1990
Summary
Children with Down's syndrome and vesico-ureteric reflux (VUR) face significantly higher risks of kidney damage and surgical failure. This study highlights a 50% nephrectomy rate and 100% ureteric reimplantation failure in these patients.
Area of Science:
- Pediatric Urology
- Nephrology
- Clinical Genetics
Background:
- Vesico-ureteric reflux (VUR) is a common condition in children.
- Down's syndrome is associated with an increased risk of congenital anomalies, including VUR.
Observation:
- Four patients with Down's syndrome and VUR were studied.
- VUR was identified in six renal units.
- Three patients required primary nephrectomies due to VUR complications.
Findings:
- A 50% nephrectomy rate was observed in Down's syndrome patients with reflux nephropathy.
- Ureteric reimplantation failed in all three attempted cases (100% failure rate).
- These rates contrast sharply with the approximately 1% nephrectomy and reimplantation failure rates in the general pediatric population with primary VUR.
Implications:
- Patients with Down's syndrome and VUR may require specialized management strategies.
- The high failure rate of ureteric reimplantation suggests alternative treatments should be explored.
- Further research is needed to understand the underlying reasons for poor surgical outcomes in this population.