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Intrarenal reflux, or pyelotubular backflow, was detected in 9.2% of children with vesico-ureteric reflux. This finding is a definite indication for surgical intervention in pediatric patients.
Area of Science:
- Pediatric Urology
- Radiology
- Nephrology
Background:
- Vesico-ureteric reflux (VUR) is a common condition in children.
- Intrarenal reflux (IR) is a less understood complication of VUR.
- The relationship between IR and renal damage requires further investigation.
Purpose of the Study:
- To determine the incidence of intrarenal reflux in children with VUR.
- To assess the correlation between intrarenal reflux and renal damage.
- To evaluate the clinical significance of intrarenal reflux in guiding treatment decisions.
Main Methods:
- Retrospective review of 76 children with 123 ureters affected by VUR.
- Micturating cystourethrography (MCU) to detect intrarenal reflux.
- Excretion urography (EU) to assess renal morphology and damage.
Main Results:
- Intrarenal reflux was identified in 7 patients (9.2%) during MCU.
- Renal damage was observed in 6% of kidneys with VUR and IR.
- A direct correlation between IR location and renal damage was noted in some cases.
Conclusions:
- Intrarenal reflux is a significant finding in children with VUR.
- The presence of intrarenal reflux is a strong indicator for surgical intervention.
- Further research is needed to fully elucidate the pathogenesis of IR and its long-term sequelae.
Abstract:
Seventy-six children with a total of 123 ureters showing vesico-ureteric reflux were reviewed in order to detect intrarenal reflux (pyelotubular backflow) occuring during micturating cystourethrography. This was found in 7 patients (9.2%). Five patients had unilateral and two bilateral intrarenal reflux. In only 7 out of the 9 kidneys with intrarenal reflux was it possible to outline the kidney contour precisely on excretion urography. In 3 cases renal damage corresponded exactly to the areas with intrarenal reflux. One kidney showed damage which did not correspond to the location of intrarenal reflux and 3 were without signs of damage. Renal damage of varying localization was found in 54 of the 123 kidneys with vesico-ureteric reflux and intrarenal reflux was present in 6 of these (11%). The significance of intrarenal reflux as a cause of renal damage and whether intrarenal reflux might be primary or secondary to the renal damage are discussed, and it is concluded that presence of intrarenal reflux is a definite indication for operation.