title: Improvement in vesicoureteral reflux grade on serial imaging predicts resolution.
abstract: OBJECTIVE
  When children are initially diagnosed with vesicoureteral reflux most undergo a period of antibiotic prophylaxis followed by serial imaging. Although improvement in reflux grade through time presumably predicts eventual resolution, the significance of changing grade through time is unknown. We examined whether improvement in reflux on serial imaging predicts resolution.
  
  
  METHODS
  We retrospectively reviewed 1,761 children diagnosed with vesicoureteral reflux, of whom 965 had a minimum of 2 years of followup. We examined initial reflux grade and grade on serial imaging up to 5 years after the original diagnosis. For each child it was determined whether reflux was resolved, eventually resolved or never resolved. Groups were further stratified by clinical characteristics.
  
  
  RESULTS
  Multivariate analysis revealed that male gender (HR 1.33, p = 0.05), age younger than 1 year at diagnosis (HR 1.35, p = 0.004), lower grade at presentation (grade I HR 2.2, grade II HR 1.96, grade III HR 1.33; p <0.001) and unilateral reflux (HR 1.39, p = 0.001) were all independent predictors of reflux resolution. Multivariate analysis also showed that reflux improvement on imaging 1 year after diagnosis (HR 3.14, p <0.0001) and improvement from the previous year at any point during followup (HR 1.8, p = 0.009) were independent predictors of reflux resolution.
  
  
  CONCLUSIONS
  Consistent with previous findings, male gender, lower reflux grade at presentation, age less than 1 year at presentation and unilateral reflux were all predictive of reflux resolution. Our analysis also demonstrated that improvement in reflux grade on imaging study 1 year after diagnosis was predictive of resolution, and that reflux improvement from the previous year at any point during followup was an independent predictor of resolution. This information will prove valuable in clinical counseling and therapeutic decision making.
authors.affiliation: Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Glenn M
authors.initials: GM
authors.lastname: Cannon
authors.forename: Ayrton A
authors.initials: AA
authors.lastname: Arahna
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.forename: Carlo C
authors.initials: CC
authors.lastname: Passerotti
authors.forename: Andres
authors.initials: A
authors.lastname: Silva
authors.forename: Alan B
authors.initials: AB
authors.lastname: Retik
authors.forename: Hiep T
authors.initials: HT
authors.lastname: Nguyen
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D014718:Vesico-Ureteral Reflux / Q000145:classification / Q000000981:diagnostic imaging*