Abstract
The authors present compelling work on a controversial topic: the pathogenesis of renal damage in patients with VUR. The authors propose that renal scarring in patients with VUR is mediated through RAS activation. They report a temporary decline in plasma renin activity following reflux surgery with further improvement in renal function which was maintained with the addition of an ACE-I. The authors recommend ACE-I ‘soon’ after surgery to prevent further renal injury but only have data for patients on medical therapy in the late postoperative period. Should one be surprised that following ACE-I administration an improvement in several renal parameters was seen knowing the renal protective effects of ACE-I in patients with renal dysfunction? Given the high preponderance of boys in the study group and the degree of renal dysfunction found during
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