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Renal function following surgical correction of vesico-ureteric reflux in childhood
Insights
Surgical correction of vesico-ureteric reflux significantly improved kidney function in children with scarred kidneys. Ureteric reimplantation led to notable gains in glomerular filtration rate (GFR), especially in those with more severe kidney damage.
Area of Science:
- Pediatric Urology
- Nephrology
- Surgical Outcomes
Background:
- Vesico-ureteric reflux (VUR) can lead to renal scarring and impaired kidney function in children.
- Surgical correction aims to prevent further renal damage and preserve renal function.
- Long-term assessment of renal function post-ureteric reimplantation is crucial for understanding treatment efficacy.
Purpose of the Study:
- To evaluate the effectiveness of surgical correction for vesico-ureteric reflux on renal function.
- To assess changes in glomerular filtration rate (GFR) in children with scarred kidneys after ureteric reimplantation.
Main Methods:
- Retrospective analysis of 56 children (aged 2-15 years) who underwent ureteric reimplantation for VUR between 1978 and 1983.
- Exclusion of patients with coexisting urological diseases.
- Measurement of current renal function, specifically glomerular filtration rate (GFR), post-surgery.
Main Results:
- Significant improvement in overall GFR (P < 0.001) was observed in 75% of patients who had bilateral ureteric reimplantation for bilaterally scarred kidneys.
- The greatest GFR improvement (29%) occurred in patients with pre-operative GFR < 50 ml/min/1.73 m2.
- Estimated individual kidney GFR improved in 81% of 42 assessed kidneys post-surgery (P < 0.001).
Conclusions:
- Ureteric reimplantation is an effective surgical treatment for improving renal function in children with scarred kidneys due to VUR.
- The procedure demonstrates significant benefits in preserving and enhancing glomerular filtration rate, particularly in cases of more advanced renal damage.
- Surgical correction of VUR contributes positively to long-term renal health outcomes in pediatric patients.
Abstract:
To assess the effectiveness of the surgical correction of vesico-ureteric reflux, current renal function was determined in 56 children with scarred kidneys who had undergone ureteric reimplantation between 1978 and 1983. The children were aged between 2 and 15 years, had no coexisting urological disease and a glomerular filtration rate (GFR) of less than 90 ml/min/1.73 m2. In the 32 patients who had bilateral reimplantation of ureters draining bilaterally scarred kidneys the improvement in GFR following surgery was highly significant (P less than 0.001), with improvement occurring in 75%. The greatest improvement was in patients where the GFR was less than 50 ml/min/1.73 m2 (29%). Individual kidney GFR was estimated in 42 kidneys and 81% improved after surgery. This improvement was highly significant (P less than 0.001).