title: Longitudinal development of renal damage and renal function in infants with high grade vesicoureteral reflux.
abstract: OBJECTIVE
  We sought to study renal abnormality and renal function through time in infants with high grade vesicoureteral reflux.
  
  
  METHODS
  This prospective observational study included 115 infants (80 boys and 35 girls) younger than 1 year with grade III to V vesicoureteral reflux. The diagnosis was made after prenatal ultrasound in 26% of the patients and after urinary tract infection in 71%. Patients were followed by renal scintigraphy, 51chromium edetic acid clearance and video cystometry. Median followup was 62 months.
  
  
  RESULTS
  Renal abnormality, which was found in 90% of the children at followup, was generalized in 71% and focal in 29%. The abnormality was bilateral in 28% of the affected patients. Total glomerular filtration rate was less than 80% of expected in 30% of the patients. Single kidney function was less than 40% of expected total glomerular filtration rate in 71% of the patients. Renal status (parenchymal abnormality and function) remained unchanged through time in 84 of 108 available cases (78%), improved in 5 (5%) and deteriorated in 19 (18%). Predictive factors for deterioration were recurrent febrile urinary tract infection, bilateral abnormality and reduced total glomerular filtration rate. Deteriorated renal status was more common in cases diagnosed prenatally than in those detected after urinary tract infection.
  
  
  CONCLUSIONS
  Among these infants with high grade vesicoureteral reflux renal abnormality was frequent and was associated with subnormal filtration of one of the kidneys. Decreased total glomerular filtration rate was seen in about a third of the patients. Overall deterioration of renal status was seen in only a fifth of the patients. Infection control seems to be an important factor to minimize the risk.
authors.affiliation: Department of Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden. sofia.sjostrom@vgregion.se
authors.forename: Sofia
authors.initials: S
authors.lastname: Sjöström
authors.forename: Ulf
authors.initials: U
authors.lastname: Jodal
authors.forename: Rune
authors.initials: R
authors.lastname: Sixt
authors.forename: Marc
authors.initials: M
authors.lastname: Bachelard
authors.forename: Ulla
authors.initials: U
authors.lastname: Sillén
mesh_terms: D017677:Age Distribution; D003558:Cystoscopy / Q000379:methods; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007223:Infant; D007677:Kidney Function Tests; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000151:congenital / Q000175:diagnosis*; D014741:Video Recording