Role of plasma renin activity in the management of primary vesicoureteric reflux: a preliminary report.
BACKGROUND
Nonoperative management is the choice of therapy in most patients with primary vesicoureteric reflux (VUR). Such patients are regularly monitored for breakthrough urinary tract infection, deterioration of renal function, and progression/ appearance of new scars as the indicators for switching over to surgical intervention. In this descriptive study, we report our additional observations on serial measurement of plasma renin activity (PRA) in a group of such children followed prospectively.


METHODS
Twenty-six children (16 males and 10 females) with various grades (grades I to V) of primary VUR were enrolled. Besides the conventional investigations, we also monitored PRA. Ureteric reimplantation was performed based on established international criteria. PRA levels were correlated with the need for surgical intervention retrospectively.


RESULTS
Mean age at presentation was 39.3 months (range, 12 to 120 months). Nineteen children (73%) were subjected to ureteric reimplantation. The mean PRA in this group (N = 19) was 6.97 ng/mL/hour versus 3.28 ng/mL/hour in patients who were continued on nonoperative management (N = 7). Postoperatively, the PRA reduced and stabilized in all 18 patients at a mean value of 5.4 ng/mL/hour.


CONCLUSIONS
The currently accepted end points of medical management are inconsistent. On the other hand, 94.7% of children in the surgical group had shown an activation and a progressive increase in PRA. Postoperatively, the PRA was reduced and stabilized in all these patients. Our preliminary observations suggest that high PRA is a more sensitive indicator for surgical intervention as compared to the existing criteria.
Bajpai
Minu
M
Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India. bajpai2@hotmail.com
Pal
Kamlesh
K
Bal
Chandrashekhar S
CS
Gupta
Arun K
AK
Pandey
Ravinder M
RM
D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012083:Renin / Q000097:blood*; D012720:Severity of Illness Index; D014718:Vesico-Ureteral Reflux / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery
D015415:Biomarkers; D012083:Renin