Renal involvement in children with vesicoureteral reflux: are prenatal detection and surgical approaches preventive?
OBJECTIVE
Surgical correction of vesicoureteral reflux (VUR) and prolonged administration of antibiotics seem to lead to similar renal outcomes. However, it is not known whether prenatal recognition and the position of VUR modify the outcome in different ways. The purpose of this study was to investigate the effects of prenatal detection and different treatment methods on the outcome of unilateral refluxing renal units.


METHODS
This retrospective study enrolled 119 children (mean age 2.8+/-3.5 years) with primary VUR. Kidney growth and renal function were measured with ultrasound and scintigraphy, respectively. To compare the ultrasound readings among patients of different ages the comparative-length index or index was calculated, as a percentage of the ratio of unilateral and the sum of bilateral renal length.


RESULTS
In unilateral refluxing renal units there was a reduction in both index and function, whereas not-refluxing was increased. In the follow-up, unilateral refluxing renal units had a worse index, whereas not-refluxing was better. Unexpectedly, surgical therapy of the left-refluxing renal unit led to a reduction in the index, whereas its function always stayed low in diagnosis but stable. The outcome of severely refluxing renal units was similar after both interventions. Prenatal and postnatal diagnosis did not seem to modify the renal result.


CONCLUSIONS
Surgery showed similar renal outcomes to medical treatment. A kidney growth defect from high-grade VUR was detected in the diagnosis. Therefore, a congenitally damaged kidney does not ameliorate after each treatment. Finally, prenatal detection of VUR does not seem to modify the outcome of the kidney significantly.
Zaffanello
Marco
M
Department of Mother-Child and Biology-Genetics, University of Verona, Verona, Italy. marco.zaffanello@univr.it
Brugnara
Milena
M
Cecchetto
Mariangela
M
Fedrizzi
Michela
M
Fanos
Vassilios
V
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007674:Kidney Diseases / Q000382:microbiology / Q000517:prevention & control; D008297:Male; D011296:Prenatal Diagnosis; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000517:prevention & control* / Q000601:surgery
D000900:Anti-Bacterial Agents