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Vesicoureteral Reflux Index: 2-Institution Analysis and Validation

Angela M Arlen1, Michael Garcia-Roig2, Aaron D Weiss2

  • 1Department of Urology and Pediatrics, University of Iowa Hospitals and Clinics, Iowa City, Iowa.

The Journal of Urology
|March 28, 2015
PubMed

Insights

The vesicoureteral reflux index accurately predicts spontaneous resolution in infants with vesicoureteral reflux (VUR). This tool aids in personalized management for children diagnosed with VUR before age two.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Medical Diagnostics

Background:

  • Vesicoureteral reflux (VUR) is common in infants, with spontaneous resolution rates varying significantly.
  • Predicting VUR resolution is crucial for guiding treatment and minimizing complications like renal scarring.
  • Novel tools are needed to accurately assess VUR prognosis in young children.

Purpose of the Study:

  • To validate the discriminatory power of the vesicoureteral reflux index (VRI) in predicting spontaneous VUR resolution.
  • To assess the VRI's ability to predict the rate of VUR resolution in children under 2 years old.

Main Methods:

  • A multi-institutional study evaluated patients diagnosed with primary VUR before 24 months of age.
  • Data included demographics, VUR grade and timing, ureteral anomalies, and radiographic outcomes.
  • Time-to-event analysis using the C-index was performed to assess resolution rates.

Main Results:

  • The study included 369 children (219 girls, 150 boys) with a mean age at diagnosis of 4.7 months.
  • VUR resolution rates decreased as the VRI score increased (e.g., 88.2% for VRI 1 vs. 14.3% for VRI ≥5).
  • Factors like filling phase VUR, high-grade reflux, and ureteral anomalies were associated with longer resolution times.

Conclusions:

  • The vesicoureteral reflux index is a simple, reliable tool for predicting VUR improvement and spontaneous resolution in infants.
  • The VRI provides valuable prognostic information to guide individualized patient care for VUR.
  • This index can help clinicians make informed decisions regarding observation versus surgical intervention.
Abstract

Keywords:
decision support techniqueskidneyremissionspontaneousuretervesico-ureteral reflux

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