Long-term clinical follow up of children with primary vesicoureteric reflux.
Fifty-six children (35 boys and 21 girls) below the age of 12 years with primary Vesicoureteric reflux (VUR) detected by voiding cystourethrogram after an initial episode of documented urinary tract infection (UTI), were studied prospectively for a period of 6-12 years (Mean 8 years) with reference to scarring, grade of reflux, break-through infections, adverse effects to prophylactic drugs and clinical and laboratory evidence of renal failure. The mean age at presentation was 1.95 years. Grade I-V reflux occurred in 7.1%, 28.6%, 48.2%, 12.5%, 3.6% respectively. Thirty-one (55.3%) had detectable renal scars on dimercaptosuccinic acid (DMSA) scan. All of them were treated with low dose prophylactic antibiotics until the age of 5 years. None had any major adverse effects to the prophylactic antibiotics. Ten (17.9%) had breakthrough UTI while on prophylaxis and 3 (5.4%) had UTI after discontinuing prophylaxis at 5 years of age. Two patients underwent ureteric reimplantation. Clinical and laboratory evidence of renal failure was not observed during the follow up period. Systolic blood pressure of all patients was below the 90th percentile for age. One had significant proteinuria. Majority of this cohort of patients with varying degrees of reflux nephropathy were managed conservatively with regular monitoring and low-dose prophylactic antibiotic therapy.
Abeysekara
C K
CK
Department of Pediatrics, Faculty of Medicine, University of Peradeniya, Sri Lanka. chandrakum@hotmail.com
Yasaratna
B M C D
BM
Abeyanunawardena
A S
AS
D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013188:Sri Lanka; D016896:Treatment Outcome; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000628:therapy*