Related Experiment Videos
[Renal dysfunction in children with vesicoureteral reflux]
Insights
Reflux nephropathy is a common cause of end-stage renal failure in children. Early detection and management of vesicoureteral reflux (VUR) are crucial to prevent kidney dysfunction progression.
Area of Science:
- Pediatric Nephrology
- Urology
Context:
- Reflux nephropathy is a leading cause of end-stage renal failure (ESRF) in pediatric populations.
- Vesicoureteral reflux (VUR) is a significant risk factor for renal damage and subsequent kidney dysfunction.
Purpose:
- To retrospectively analyze the clinical course and outcomes of 28 children with VUR and impaired renal function.
- To evaluate the impact of antireflux surgery on the progression of renal dysfunction in this cohort.
Summary:
- The study identified 28 children with VUR and impaired renal function (serum creatinine >1.0 mg/dl or BUN >20 mg/dl).
- Proteinuria and hypertension were common, with 5 patients progressing to ESRF.
- Bilateral reflux and moderate-to-severe reflux were prevalent. Renal dysfunction progression varied, with limited improvement post-surgery.
- Antireflux surgery demonstrated minimal impact on improving renal function, highlighting the need for early intervention.
Impact:
- Emphasizes the critical need for early detection and prompt management of VUR to mitigate the risk of progressive renal dysfunction and ESRF in children.
- Findings underscore that antireflux surgery alone may not be sufficient to reverse established renal damage, necessitating a comprehensive approach to VUR management.
Abstract:
It is well recognized that reflux nephropathy is one of the commonest causes of end-stage renal failure (ESRF) in children. We made a retrospective study of 28 children with vesicoureteral reflux (VUR) who showed impaired renal function, as defined by either the serum creatinine of more than 1.0 mg/dl or BUN of more than 20 mg/dl. There were 20 boys and 8 girls, and the incidence of both sexes was 4.8% and 1.9% respectively. Of patients, proteinuria was detected in 22, and hypertension in 7. Five patients progressed to ESRF during his or her clinical course. About half of the patients in this series presented proteinuria or growth retardation which had led to urological check-up. Bilateral reflux was demonstrated in 24 patients, and all of the remaining 4 with unilateral reflux had hypoplastic or dysplastic contralateral kidney. Micturition cystourethrography revealed moderate or severe reflux in 86% of the ureters either at the first examination or during the follow-up periods. Urographic findings which suggested renal dysfunction included bilateral small kidney, unilateral small kidney with contralateral renal scarring, and bilateral generalized renal scarring. According to the pattern of the progression of renal dysfunction, patients were subdivided into 3 groups. Group I; patients showed bilateral renal hypoplasia on urography, and renal dysfunction progressed to ESRF before the age of 10 years despite surgical treatment. In patients of group II, gradual decrease of renal function led to ESRF at the age of puberty, although SCr was around 1.2-1.5 mg/dl when they were about 10 years old. In group III, renal function was stable at about 1.0 mg/dl of SCr during childhood. Temporary improvement of renal function was observed in only 3 of 21 children who were followed for more than 1 year after antireflux surgery. Deterioration of renal function was caused within 6 months to one year. Antireflux surgery had only little influence on the improvement of renal function in this series. We emphasize the need for early detection and management of reflux to prevent progression of renal dysfunction.