Renal scarring and vesicoureteral reflux in children with myelodysplasia.
The records of 180 myelodysplasia patients followed from 3 to 18 years were reviewed. Studies included cystography to evaluate vesicoureteral reflux and dimercapto-succinic acid renal scintigraphy to identify acute inflammation and renal scarring. Scarring was noted in 28 of 180 patients (15.5%), of whom 68% were girls. Of the patients with renal scarring 75% had associated reflux and 40% over-all were identified as having reflux. Management of patients with vesicoureteral reflux included clean intermittent catheterization, antibiotic prophylaxis and anticholinergics when indicated. Only 17 of 72 patients (24%) had ureteral reimplantation. Surgical indications included persistent high grade reflux and/or progressive upper tract damage. Reflux resolved in 62% of those on medical management. Resolution was not dependent on grade of reflux (as compared to primary reflux). Twenty-one patients are stable and being followed with persistent reflux. In 7 patients new renal scars developed during aggressive medical management, 5 of whom underwent subsequent surgical correction.
Cohen
R A
RA
Department of Urology, Children's Hospital, Washington, D.C. 20010.
Rushton
H G
HG
Belman
A B
AB
Kass
E J
EJ
Majd
M
M
Shaer
C
C
D002648:Child; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D009436:Neural Tube Defects / Q000150:complications*; D015609:Organotechnetium Compounds; D011877:Radionuclide Imaging; D004113:Succimer; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D014718:Vesico-Ureteral Reflux / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology* / Q000628:therapy
D015609:Organotechnetium Compounds; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D004113:Succimer