Features of primary vesicoureteral reflux and renal damage in children at a single institution in Brazil from 1969 to 1999.
OBJECTIVE
The purpose of the study was to evaluate the clinical/radiological features of patients with primary vesicoureteral reflux (VUR) admitted to a single institution from 1969 to 1999.


METHODS
The patients' records were retrospectively reviewed and the following clinical data obtained at admission were analyzed: age, gender, race, date of entry, previous symptoms, weight, height, blood pressure, and serum renal function. The renal imaging tests at baseline were also retrospectively analyzed including voiding cystourethrography, excretory urography, DMSA scan, and ultrasonography. For statistical analysis, reflux was classified into two categories: (1) mild/moderate (grade I/II/III) and (2) severe (grade IV/IV). Renal damage was categorized according to the following classification: (I) mild, focal damage; (II) moderate, more extensive scars, and (III) severe, generalized damage or shrunken kidney. The odds ratio (OR) and the respective confidence interval (95%CI) were calculated to compare the difference in risk between groups.


RESULTS
A total of 461 patients were enrolled in the protocol. There was a predominance of female gender (71%) and white race (73%). Mean age at VUR diagnosis was 2.8 y and 93% of the patients had urinary infection before admission. Bilateral reflux was diagnosed in 249 (54%) children, for a total of 710 renal units for study. The distribution of reflux grade was as follows: grade I (7%); II (36%); III (26%); IV (23%), and V (8%). Of the 450 children investigated, 180 (40%) presented with renal damage, for a total of 234 (26%) units with renal scars. Renal damage was associated with the following factors: Diagnosis after 2 y of age (OR = 1.5, 95%CI = 1.08-2.1, p = 0.01), severe degree of reflux (OR = 6, 95%CI = 4-9, p < 0.001). There was a significant risk of severe renal damage for male gender (OR = 1.9, IC95% = 1.3-2.1, p = 0.001).


CONCLUSIONS
There was a predominance of renal damage in children diagnosed above 2 y and with a high degree of reflux. Severe renal damage was associated with male gender.
Silva
José Maria Penido
JM
Pediatric Nephrourology Unit, Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil.
Diniz
José Silvério S
JS
Oliveira
Eduardo A
EA
Cardoso
Luís Sérgio Bahia
LS
Marino
Viviane S P
VS
Pimenta
Mariana R
MR
Matos
Carolina C
CC
Vieira
Samana B
SB
D000293:Adolescent; D017677:Age Distribution; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006268:Health Facilities; D006801:Humans; D007223:Infant; D007674:Kidney Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D008297:Male; D012189:Retrospective Studies; D017678:Sex Distribution; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology