Renal dysfunction in children with vesicoureteral reflux

Abstract

It is well recognized that reflux nephropathy is one of the commonest causes of end-stage renal failure (ESRF) in children. We made a retrospective study of 28 children with vesicoureteral reflux (VUR) who showed impaired renal function, as defined by either the serum creatinine of more than 1.0 mg/dl or BUN of more than 20 mg/dl. There were 20 boys and 8 girls, and the incidence of both sexes was 4.8% and 1.9% respectively. Of patients, proteinuria was detected in 22, and hypertension in 7. Five patients progressed to ESRF during his or her clinical course. About half of the patients in this series presented proteinuria or growth retardation which had led to urological check-up. Bilateral reflux was demonstrated in 24 patients, and all of the remaining 4 with unilateral reflux had hypoplastic or dysplastic contralateral kidney. Micturition cystourethrography revealed moderate or severe reflux in 86% of the ureters either at the first examination or during the follow-up periods. Urographic findings which suggested renal dysfunction included bilateral small kidney, unilateral small kidney with contralateral renal scarring, and bilateral generalized renal scarring. According to the pattern of the progression of renal dysfunction, patients were subdivided into 3 groups. Group I; patients showed bilateral renal hypoplasia on urography, and renal dysfunction progressed to ESRF before the age of 10 years despite surgical treatment. In patients of group II, gradual decrease of renal function led to ESRF at the age of puberty, although SCr was around 1.2-1.5 mg/dl when they were about 10 years old. In group III, renal function was stable at about 1.0 mg/dl of SCr during childhood. Temporary improvement of renal function was observed in only 3 of 21 children who were followed for more than 1 year after antireflux surgery. Deterioration of renal function was caused within 6 months to one year. Antireflux surgery had only little influence on the improvement of renal function in this series. We emphasize the need for early detection and management of reflux to prevent progression of renal dysfunction.