Long-term outcome of vesicoureteral reflux associated chronic renal failure in children. Data from the ItalKid Project.
OBJECTIVE
The nephropathy associated with vesicoureteral reflux (VUR) is one of the leading causes of chronic renal failure (CRF) in children. We describe the clinical course of the disease based on information available in the ItalKid Project database, and analyze the predictive value of baseline renal function, age at VUR diagnosis and urinary protein excretion in relation to the risk of progressive renal failure.


METHODS
As of December 31, 2001 the registry included a total of 343 patients (261 males) with a diagnosis of primary VUR, which was the leading single cause of CRF, accounting for 25.4% of all patients with CRF.


RESULTS
The estimated risk of end stage renal disease (ESRD) by age 20 years was 56%. The patients with a creatinine clearance (Ccr) of less than 40 ml per minute at baseline had an estimated 4-fold greater risk of ESRD developing in comparison with those whose Ccr was 40 to 75 ml per minute. No significant difference in probability of disease progression to ESRD was found between subjects diagnosed with VUR at age 6 months or less and those diagnosed later (older than 6 months). Furthermore, children with normal urinary protein excretion (a urinary protein [uPr]/urinary creatinine [uCr] ratio of less than 0.2 in 36 patients) and low grade proteinuria (uPr/uCr 0.2 to 0.8 in 34 patients) at baseline showed a significantly slower decrease in mean Ccr than those with moderate proteinuria (uPr/uCr greater than 0.8 in 34 patients). Hypertension and/or antihypertensive treatment (including antiprogressive drugs) were reported in 29.1% of patients.


CONCLUSIONS
The results of the present study define the long-term risk of ESRD in a large population of children with CRF and VUR, and provide some critical information for identifying the prognosis.
Ardissino
Gianluigi
G
Unit of Pediatric Nephrology, Dialysis and Transplantation, IRCCS Ospedale Maggiore, Milan, Italy.
Avolio
Luigi
L
Dacco
Valeria
V
Testa
Sara
S
Marra
Giuseppina
G
Viganò
Sara
S
Loi
Silvana
S
Caione
Paolo
P
De Castro
Roberto
R
De Pascale
Salvatore
S
Marras
Efisia
E
Riccipetitoni
Giovanna
G
Selvaggio
Giorgio
G
Pedotti
Paola
P
Claris-Appiani
Aldo
A
Ciofani
Antonio
A
Dello Strologo
Luca
L
Lama
Giuliana
G
Montini
Giovanni
G
Verrina
Enrico
E
D002648:Child; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D008297:Male; D011379:Prognosis; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000503:physiopathology / Q000652:urine
D003404:Creatinine