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Persistent renin-angiotensin system activation after anti-reflux surgery and its management

Minu Bajpai1, C S Bal, Rakesh Kumar

  • 1Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India. bajpai2@hotmail.com

Journal of Pediatric Urology
|August 3, 2011
PubMed

Insights

Anti-reflux surgery initially improves kidney function by down-regulating the renin-angiotensin system. However, this effect wanes over time, but angiotensin-converting enzyme inhibitors (ACE-I) can aid renal recovery.

Area of Science:

  • Pediatric Nephrology
  • Urology

Background:

  • Vesicoureteral reflux (VUR) in children can lead to renal scarring and dysfunction.
  • The renin-angiotensin system (RAS) plays a role in renal hemodynamics and function.
  • Anti-reflux surgery is a common treatment for high-grade VUR.

Purpose of the Study:

  • To investigate the activation of the renin-angiotensin system (RAS) following anti-reflux surgery in children.
  • To evaluate the efficacy of angiotensin-converting enzyme inhibitors (ACE-I) in improving renal function post-surgery.

Main Methods:

  • Thirty-nine children with high-grade primary VUR underwent anti-reflux surgery.
  • Postoperative monitoring included plasma renin activity (PRA), urinary microalbumin, renal scars, split renal function (SRF), glomerular filtration rate (GFR), serum creatinine, blood pressure, and urinary tract infections.
  • Patients were assessed in early and late postoperative phases, and before and after ACE-I therapy.

Main Results:

  • Early postoperative period showed improvement in renal parameters (SRF, GFR) and a significant decrease in PRA.
  • These improvements were not sustained in the late postoperative phase, with a notable rise in PRA.
  • Following ACE-I therapy, there was a modest improvement in SRF and GFR, and a significant reduction in urinary microalbumin.

Conclusions:

  • The beneficial effects of anti-reflux surgery on RAS activation and renal function are temporary.
  • Long-term follow-up is necessary to monitor renal parameters after anti-reflux surgery.
  • Angiotensin-converting enzyme inhibitors (ACE-I) demonstrate a role in aiding renal recovery in children post anti-reflux surgery.
Abstract

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