[Chronic renal failure secondary to vesicoureteral reflux: is the prevention possible?]

Area of Science:

• Pediatric Nephrology
• Urology
• Clinical Research

Background:

• Vesicoureteral reflux (VUR) is the most frequent cause of end-stage renal failure in children.
• The ITALKID registry identifies VUR as a primary cause of chronic renal failure (CRF) in pediatric populations.
• Understanding the long-term impact of VUR diagnosis and treatment is crucial for pediatric kidney health.

Purpose of the Study:

• To analyze the outcomes of 131 children diagnosed with VUR between 1987 and 1994.
• To evaluate the effectiveness of early VUR diagnosis in preventing chronic renal failure (CRF).
• To assess the diagnostic utility of prenatal ultrasonography for VUR detection.

Main Methods:

• Retrospective analysis of 131 pediatric patients diagnosed with VUR.
• Data collection on age at diagnosis, diagnostic methods (prenatal ultrasound, urinary tract infection symptoms, poor growth), and treatment (conservative vs. surgical).
• Assessment of CRF development in relation to age at diagnosis and treatment modality.

Main Results:

• VUR diagnosis occurred in 69% of cases within the first year of life.
• Urinary tract infection was the most common presenting symptom (94/131).
• Prenatal ultrasonography showed low sensitivity (24/131) for VUR diagnosis.
• Despite early diagnosis in 79% of cases within the first year, 14% (19/131) developed CRF.
• Conservative management (chemoprophylaxis) was used in 75/131 patients, while 56/131 underwent antireflux surgery.

Conclusions:

• Prenatal ultrasonography has limited sensitivity in diagnosing VUR.
• Early diagnosis of VUR during the first year of life does not guarantee prevention of chronic renal failure (CRF).
• The high prevalence of CRF and surgical interventions may be linked to the referral center's catchment area and patient population characteristics.