title: Role of endoscopic treatment of vesico-ureteric reflux in downgrading renin angiotensin system activation.
abstract: OBJECTIVE
  The objective of this study was to assess the role of endoscopic treatment of vesico-ureteric reflux (VUR) in downgrading renin angiotensin system (RAS) activation.
  
  
  METHODS
  Of 115 patients diagnosed and treated for VUR, 63 underwent hyaluronic acid/dextranomer (deflux) injection in a total of 99 ureteric moieties. Patients were monitored for urinary tract infection (UTI), glomerular filtration rate (GFR), plasma renin activity (PRA), renal scarring, persistence, or appearance of contra-lateral reflux.
  
  
  RESULTS
  Grade III VUR was most common (38%), and the most common cause of VUR was primary (60%). Analysis of patient characteristics at presentation revealed increased PRA in most cases (68%). Grade I VUR showed the most avid decrease in serum PRA levels after single injection. Serum PRA levels were sustainably low in patients of grade I and II VUR, whereas in patients of grade III values kept rising after reaching nadir. This increase in PRA levels correlated well with persistence of symptoms and reappearance of VUR in some patients.
  
  
  CONCLUSIONS
  PRA levels can be used as an indicator to initiate treatment of VUR. They can also be used for monitoring the progress of the disease and efficacy of the treatment given.
authors: All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: talk2ajayverma@gmail.com.
authors: Ajay
authors: A
authors: Verma
authors: All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: drshasank_aiims@yahoo.co.in.
authors: Shasanka S
authors: SS
authors: Panda
authors: All India Institute of Medical Sciences, New Delhi 110029, India. Electronic address: bajpai2@hotmail.com.
authors: Minu
authors: M
authors: Bajpai
mesh_terms: D000283:Administration, Intravesical; D002675:Child, Preschool; D015331:Cohort Studies; D003558:Cystoscopy / Q000379:methods; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000627:therapeutic use*; D007223:Infant; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012084:Renin-Angiotensin System / Q000187:drug effects*; D012189:Retrospective Studies; D018570:Risk Assessment; D012380:Role; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome; D014563:Urodynamics; D014718:Vesico-Ureteral Reflux / Q000175:diagnosis* / Q000601:surgery*
chemical_list: D006820:Hyaluronic Acid
keywords: Deflux; Renin angiotensin system; Vesico-ureteric reflux