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[The treatment of the primary intrarenal reflux. Is the surgery always necessary?]
C Miguélez Lago1, E Galiano Duro, M García Mérida
1Servicio de cirugía Pediátrica, Hospital Materno Infantil de Málaga.
Insights
Intrarenal reflux (I.R.R.) in children can often be successfully treated non-surgically, especially in milder cases without reflux nephropathy (R.N.). This study shows high success rates for both surgical and non-surgical interventions in managing I.R.R.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Imaging
Context:
- Intrarenal reflux (I.R.R.) is a significant concern in pediatric kidney health.
- Understanding the relationship between I.R.R. and reflux nephropathy (R.N.) is crucial for effective treatment strategies.
- Early diagnosis and management are key in preventing long-term renal damage.
Purpose:
- To evaluate the relationship between intrarenal reflux (I.R.R.) and reflux nephropathy (R.N.).
- To assess the outcomes of both surgical and non-surgical treatments for I.R.R. in children.
- To identify criteria for selecting appropriate treatment modalities.
Summary:
- This study analyzed 51 children (64 kidneys) with primary I.R.R., with 53% under one year old.
- Initial examinations included urography, ultrasounds, cystography, and DMSA scans.
- Reflux nephropathy (R.N.) was present in 47% of kidneys; higher reflux grades (IV-V) showed significantly higher R.N. rates (70%) compared to lower grades (II-III, 36%).
- Surgical treatment was used in 82% of children, and non-surgical in 18%.
- Both approaches demonstrated high success rates in stopping reflux (98% surgical, 100% non-surgical).
- Only one child developed a new renal scar, and two showed progression of existing R.N.
Impact:
- Intrarenal reflux (I.R.R.) can be effectively managed with non-surgical treatment in selected pediatric cases.
- The findings support conservative management for milder I.R.R. without reflux nephropathy (R.N.).
- This research contributes to optimizing treatment algorithms for pediatric urinary tract issues, potentially reducing invasive procedures.
Unlabelled:
THE AIMS OF THIS STUDY was to evaluate the relationship between intrarenal reflux (I.R.R.) and reflux nephropathy (R.N.) in order to know the results of surgical and non surgical treatment. Fifty one children with 64 kidneys with primary I.R.R. were studied. 53% of them were less than one year of age. Initial examination were: urography, ultrasounds, cystography and DMSA scan; the follow up was done with ultrasounds, DMSA scan and cystography. When no R.N. was present, grade of reflux was < IV, and age < 12 years, a non surgical treatment was indicated.
Results:
During first examination R.N. was demonstrated in 47% of kidneys; the main difference was the grade of reflux: 16/44 II-III (36%) and 14/20 IV-V (70%). Surgical treatment was performed in 42 (82%) children and non surgical in 9 (18%). Reflux stopped in 98% and 100%, respectively. Only one child, without R.N., developed a new renal scar, and a previous R.N. progressed in two. I.R.R. can be treated successfully without surgery in selected cases.