title: Clinical course of 735 children and adolescents with primary vesicoureteral reflux.
abstract: The purpose of this retrospective cohort study was to report the clinical course of children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR and were systematically followed in a single tertiary renal unit. Patients were followed up for a mean time of 76 months (6 months to 411 months). The events of interest were reflux resolution, renal damage, urinary tract infection (UTI), chronic kidney disease (CKD), and hypertension. Survival analysis was performed in order to evaluate reflux resolution and CKD. Renal damage was detected at admission in 319 patients (43.4%). Continuous low-dose antibiotic prophylaxis was administered to 624 patients (91.2%); 499 (73%) patients subsequently had no UTI or fewer than three episodes. The median time of persistence of reflux according to Kaplan-Meier analysis was 38 months for grade I/II [95% confidence interval (95% CI), 33-43], 98 months for grade III (95% CI, 78.5-105), and 156 months for grade IV/V (95% CI, 122-189). Twenty patients (3%) developed hypertension. It was estimated that the probability of CKD was 5% at 10 years after diagnosis of VUR; for children diagnosed after 1990 the probability of CKD was only 2%. Renal function impairment occurred in patients with severe bilateral reflux or in patients with contralateral renal hypoplasia. There has been an improvement of prognosis for patients diagnosed in the past 15 years.
authors.affiliation: Pediatric Nephrourology Unit, Department of Pediatrics, Hospital Das Clinicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil.
authors.forename: Jose Maria Penido
authors.initials: JM
authors.lastname: Silva
authors.forename: Jose Silverio
authors.initials: JS
authors.lastname: Santos Diniz
authors.forename: Viviane Santuari Parizzoto
authors.initials: VS
authors.lastname: Marino
authors.forename: Eleonora Moreira
authors.initials: EM
authors.lastname: Lima
authors.forename: Luis Sergio Bahia
authors.initials: LS
authors.lastname: Cardoso
authors.forename: Mariana Affonso
authors.initials: MA
authors.lastname: Vasconcelos
authors.forename: Eduardo Araujo
authors.initials: EA
authors.lastname: Oliveira
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000628:therapy; D007223:Infant; D007231:Infant, Newborn; D007674:Kidney Diseases / Q000175:diagnosis / Q000628:therapy; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000628:therapy; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000628:therapy