Medical treatment of vesicoureteral reflux detected in infancy
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A B Pintér1, V Jászai, I Dóber
1Surgical Unit of Children's Department, University Medical School of Pécs, Hungary.
Insights
Medical management of mild vesicoureteral reflux (VUR) in infants can lead to resolution and improved growth. Persistent VUR, however, may impact renal growth despite treatment.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Research
Background:
- Vesicoureteral reflux (VUR) is a common condition in neonates and infants.
- Grades II and III VUR without complications were historically managed medically.
- Long-term outcomes of medical management for mild VUR require further investigation.
Purpose of the Study:
- To evaluate the long-term effects of medical management on renal function and somatic growth in infants with mild VUR.
- To compare outcomes between patients with resolved VUR and those with persistent VUR.
Main Methods:
- A cohort of 41 neonates and infants with grades II-III VUR were medically treated and followed for an average of 7.5 years.
- Patients were divided into two groups: those with VUR resolution (Group 1) and those with persistent VUR (Group 2).
- Outcomes assessed included urinary infection rates, renal function (creatinine clearance), kidney dimensions, body weight, and height.
Main Results:
- Vesicoureteral reflux resolved in 33 out of 41 patients (Group 1).
- Urinary infection severity and frequency decreased significantly more in Group 1 compared to Group 2.
- While renal function (creatinine clearance) was similar, Group 2 patients exhibited significantly less bipolar parenchymal thickness, indicating potential renal damage. Body weight and height showed improved growth trends in Group 1.
Conclusions:
- Early recognition and systematic medical treatment of mild VUR (grades II-III) appear to preserve renal function and promote growth.
- The positive impact on renal and somatic growth is less pronounced in patients with persistent VUR, highlighting the importance of reflux resolution.
Abstract:
Between 1970 and 1982, 41 neonates and infants with grades II and III vesicoureteral reflux (international classification) but with no medical or urological complications were treated medically and followed for an average of 7.5 years. In 33 of the 41 patients the vesicoureteral reflux resolved (group 1) and in 8 it persisted (group 2). The severity and frequency of urinary infection decreased to a greater degree in group 1 (p less than 0.0005) than in group 2 (p less than 0.05). There was no difference in endogenous creatinine clearance between the 2 groups. Comparison of kidney length and bipolar parenchymal thickness revealed that bipolar parenchymal thickness was significantly less in group 2 patients (p less than 0.01). Body weight tended to increase in both groups but it was greater in group 1. In both groups height was lower at the time of detection of reflux and it approached nearly normal values during followup. It is tempting to conclude that early recognition of mild forms of vesicoureteral reflux (grades II and III) and systematic medical treatment can preserve renal function and promote renal and somatic growth. However, this tendency is less pronounced in patients with persistent reflux.