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The relative function of damaged kidneys in children does not deteriorate further at 3-year follow-up

Amy Whittaker1, Maria Moon, Grant Mitchell

  • 1From the *Sydney Children's Hospital; and †Prince of Wales Hospitals, Randwick; and ‡University of New South Wales, Sydney, New South Wales, Australia.

Clinical Nuclear Medicine
|November 11, 2014
PubMed

Insights

In children with severely damaged kidneys due to vesicoureteric reflux (VUR) or urinary tract infection (UTI), relative renal function (RRF) remained stable over time. Boys face a higher risk of severe reflux nephropathy.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Nuclear Medicine

Background:

  • Kidney function is thought to decline in children with vesicoureteric reflux (VUR) or urinary tract infection (UTI) due to impaired maturation and compensatory hyperfiltration.
  • Unilateral renal scarring can significantly impact overall kidney function.

Purpose of the Study:

  • To evaluate changes in relative renal function (RRF) over time in pediatric patients with unilateral renal scarring (contributing ≤30% to overall function) secondary to VUR and/or UTI.
  • To assess the impact of surgical versus conservative management on RRF in these patients.

Main Methods:

  • A retrospective analysis of pediatric patients with unilateral renal scarring and VUR/UTI who underwent serial radionuclide studies over a 12-year period.
  • Comparison of RRF at baseline and during follow-up to determine functional changes.
  • Analysis of factors influencing RRF changes, including management strategy and initial RRF severity.

Main Results:

  • Twenty-seven boys and 3 girls (median age 0.8 years) with unilateral renal scarring were included.
  • Eight patients had unilateral VUR, 21 had bilateral VUR, and 1 had UTI without VUR. Management included reimplantation surgery (n=21) or conservative care (n=9).
  • Over a mean follow-up of 2.64 years, there was a nonsignificant mean decrease in RRF from 19% to 18%. Initial RRF severity did not affect the mean change in renal function.

Conclusions:

  • In the medium term, unilaterally severely damaged kidneys associated with VUR or UTI show no significant deterioration in RRF, regardless of surgical or conservative management.
  • Boys are identified as being at a significantly higher risk for developing severe reflux nephropathy.
Abstract

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