Clinical Course and Effective Factors of Primary Vesicoureteral Reflux
Vesicoureteral reflux (VUR) is one of the most important causes of urinary tract infection and renal failure in children. It is a potentially self-limited disease. The aim of this study was to evaluate the clinical course and significant factors in children with primary VUR. The medical charts of 125 infants and children (27.2 % males, 72.8% females) with all grades of primary VUR were retrospectively reviewed. Mean age at diagnosis was 22.3 ± 22.9 months. 52% of patients had bilateral VUR. Mild reflux (Grade I, II) was the most common initial grade. 53.6% of patients achieved spontaneous resolution. 30.1% of patients had decreased renal function on initial DMSA renal scan, significantly in males and severe VUR. Reflux nephropathy occurred in 17.6% of patients, especially in renal damage and male sex. No significant association was observed between recurrent urinary tract infection with the severity of VUR, and the presence of renal damage at admission. Age at diagnosis, gender, grade, laterality, the absence of recurrent urinary tract infection and renal damage had a significant correlation between spontaneous VUR resolution. Spontaneous resolution of primary VUR occurred significantly in female patients, age ≤ 30 months at diagnosis, mild-to-moderate VUR, unilateral reflux, the absence of recurrent urinary tract infection, and renal damage.
Silva JM, Santos Diniz JS, Marino VS, et al. Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 2006;21(7):981-8.
Mir S, Ertan P, Ozkayin N. Risk factors for renal scarring in children with primary vesicoureteral reflux disease. Saudi J Kidney Dis Transpl 2013;24 (3):600-1.
Wildbrett P, Schwebs M, Abel JR, et al. Spontaneous vesicoureteral reflux resolution in children: A ten-year single-centre experience. Afr J Paediatr Surg 2013;10(1):9-12.
Xu J, Xu H, Zhou LJ, et al. Analysis of the prognosis and clinical factors in primary vesicoureteral reflux patients. Zhonghua Er Ke Za Zhi 2012;50(8):587-92.
Nepple KG, Arlen AM, Austin JC, et al. The prognostic impact of an abnormal initial renal ultrasound on early reflux resolution. J Pediatr Urol 2011;7(4):462-6.
Sjöström S, Sillén U, Jodal U, et al. Predictive factors for resolution of congenital high grade vesicoureteral reflux in infants: results of univariate andmultivariate analyses. J Urol 2010;183(3):1177-84.
Cannon GM Jr, Arahna AA, Graham DA, et al. Improvement in vesicoureteral reflux grade on serial imaging predicts resolution. Urol 2010;183(2):709-13.
Estrada CR Jr, Passerotti CC, Graham DA, et al. Nomograms for predicting annual resolution rate of primary vesicoureteral reflux: results from 2,462 children. J Urol 2009;182(4):1535-41.
Weiss R, Tamminen-Möbius T, Koskimies O, et al. Characteristics at entry of children with severe primary vesicoureteral reflux recruited for a multicenter, international therapeutic trial comparing medical and surgical management. The International Reflux Study in Children. J Urol 1992;148(5 Pt 2):1644-9.
Goldraich NP, Goldraich IH. Follow up of conservatively treated children with high and low grade vesicoureteral reflux: a prospective study. J Urol 1992;148(5Pt 2):1688-92.
Smellie JM, Prescod NP, Shaw PJ, et al. Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults PediatrNephrol 1998;12(9):727-36.
Wang Z1, Xu H, Liu HM, et al. Clinical analysis of 139 cases of primary vesicoureteric reflux in children. Zhonghua Er Ke Za Zhi 2008;46 (7):518-21.
Abeysekara CK, Yasaratna BM, Abeyanunawardena AS. Long-term clinical follow up of children with primary vesicoureteric reflux. Indian Pediatr 2006;43(2):150-4.
Silva JM1, Diniz JS, Lima EM, et al. Independent risk factors for renal damage in a series of primary vesicoureteral reflux: a multivariate analysis. Nephrology (Carlton) 2009;14(2):198-204.
Schwab CW Jr, Wu HY, Selman H, et al. Spontaneous resolution of vesicoureteralreflux: a 15-year perspective. J Urol 2002;168(6):2594-9.
Smellie JM, Jodal U, Lax H, et al. Outcome at 10 years of severe vesicoureteric reflux managed medically: Report of the International Reflux Study in Children. J Pediatr 2001;139(5):656-63.
Silva JM, Diniz JS, Lima EM, et al. Predictive factors of resolution of primary vesicoureteric reflux: a multivariate analysis. BJU Int 2006;97(5):1063-8.
McMillan ZM, Austin JC, Knudson MJ, et al. Bladder volume at onset of reflux on initial cystogram predicts spontaneous resolution. J Urol 2006;176(4 Pt 2):1838-41.
Cannon GM, Arahna AA, Graham DA, et al. Improvement in vesicoureteral reflux grade on serial imaging predicts resolution. J Urol 2010;183(2):709-13.
Knudson MJ, Austin JC, McMillan ZM, et al. Predictive factors of early spontaneous resolution in children with primary vesicoureteral reflux. J Urol 2007;178(4Pt2):1684-8.
Zhang Y, Bailey RR. A long term follow up of adults with reflux nephropathy. N Z Med J 1995;108(998):142-4.
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