Late Renal Scarring and Loss of Kidney Function despite Successful Therapy of Vesicoureteral Reflux in Childhood: Case Report and Review of Literature

Abstract

We report on a 11 year old boy who was treated for bilateral vesicoureteral reflux grade II at our department by the age of 12 months by bilateral endoscopic injection with dextranomer / hyaluronic acid (Deflux). Because of reflux persistence on the right side an open antireflux surgery (Lich Gregoir) was performed. 10 years after initial treatment he developed serious deterioration of the left kidney function after three febrile urinary tract infections within one month. Diagnostic re-evaluation revealed bilateral recurrence of grade II reflux, which was corrected consequently by open bilateral ureteral reimplantation (Cohen technique). We discuss the available literature as to renal scarring in older children and adults after initial reflux therapy in childhood and conclude that there is no age limit to possible scar formation and that there are possible implications on follow up after “curative” therapy of vesicoureteral reflux in childhood. key words: paediatric urology, vesicoureteral reflux, endoscopic reflux therapy, Deflux, renal scarring