Evaluation of renal parenchymal damage in children with primary vesicoureteral reflux

Abstract

Objective To evaluate the clinical features of primary vesicoureteral reflux(VUR) in children and to investigate the association of sex, age, reflux grade and renal parenchymal damage(RPD) in VUR. Methods Medical records of 85 patients in Department of Pediatric Nephrology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine diagnosis as VUR from Jan.2000 to May 2012 were reviewed.VUR was diagnosed by voiding cystourethrogram(VCUG). According to the results of VCUG, patients were divided into groups of low-grade(Ⅰ-Ⅱ) VUR and high-grade(Ⅲ-Ⅴ) VUR.All cases underwent 99Tcm-dimercaptosuccinic acid(DMSA) renal scan, RPD was defined by image appearance and relative kidney uptake.The impact of patient's gender and age as well as VUR grade on RPD were compared. Results A total of 85 patients(33 boys, 52 girls) were included, of whom 59 cases(69.4%) were under 2 years old, 26 cases(30.6%) were older than 2 years.VUR was unilateral in 45 patients(52.9%) and bilateral in 40 patients(47.1%), total of 125 renal units.The high-grade VUR was 93 renal units(74.4%), the incidence of high-grade VUR was significantly higher in patients who under 2 years old, but the reflux grade showed no association with gender.RPD was found in 89 renal units(71.2%). RPD rate was associated with high-grade reflux (P=0.030), male gender (P=0.021)and age(P=0.005). Conclusions The high-grade VUR is common seen in patients under 2 years old.The risk of RPD in patients were under 2 years old and in boys.High-grade VUR is a critical risk factor of RPD in children. Key words: Vesicoureteral reflux, primary; Renal parenchymal damage; Age; Gender; Child