Clinical Course of Children and Adolescents with Primary Vesicoureteral Reflux: A retrospective study of 958 patients

Madani, Abbas; Ravanshad, Yalda; Azarfar, Anoush; Hajizadeh, Niloofar; Ataei, Nematollah; Adl, Zahra; Pournasiri, Zahra; Bagheri, Sepideh; Ravanshad, Sahar; Samazghandi, Elham

doi:10.1515/bj-2016-0016

Cited by 2 publications

(2 citation statements)

References 17 publications

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“…A longer time of follow-up in the study of Cha et al compared to our cases probably is responsible for differences in resolution rates. An average follow-up of 14 months of patients on medical treatment was found to be the resolution of VUR, and the new scar at 63% and 17.6%, respectively [12]. In our participants, new renal scars and resolution of VUR happened in 28.6% and 16.3% of patients on medical treatment, respectively.…”

Section: Discussionsupporting

confidence: 51%

“…In our participants, new renal scars and resolution of VUR happened in 28.6% and 16.3% of patients on medical treatment, respectively. Differences in grades and type of VUR as well as durations of follow-up account for different results compared to mentioned study [12]. Alsaywid et al [13] found renal scars at initial evaluation in 78.8% and 74.7% of boys with high-grade VUR diagnosed following the evaluation of prenatal hydronephrosis and UTI, respectively.…”

Section: Discussionmentioning

confidence: 71%

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Clinical course and new renal scar development in children with high-grade vesicoureteral reflux

Tafazoli,

Naseri

2023

Preprint

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Purpose: to define the resolution rate of high-grade vesicoureteral reflux (VUR) in on-to-three-year follow-up, and determine the new renal scar development. Methods: This longitudinal study was performed in children < 18 years with high-grade VUR from March 2003 to 2022. Patients who underwent radionuclide cystography 12-36 months after the diagnosis of VUR enrolled in the study and the resolution rate of VUR was calculated. Those who performed technetium-99m dimercaptosuccinic acid scans as baseline and follow-up were evaluated for new renal scarring. In the third part of the investigation, the role of different confounders was evaluated in the resolution rate of VUR and the appearance of new renal scarring. In addition, renal scarring at initial evaluation was calculated in total eligible cases who underwent a Tc-99m DMSA scan. Results: Of 216 eligible cases, 68 (31.5%) and 43 (19.9%) patients entered the study's first and second parts, respectively. They included 50% girls, with a median age at diagnosis of 31 months. Surgical interventions were performed at follow-up in 18 patients (26.5 %). Total, spontaneous, and surgical resolution rates of VUR per person at one –three-year follow-ups were 19.1% (n=13), 16 % (n=8), and 27.8 % (n=5), respectively. Renal scars and severe renal scarring were found in 135 (80.8%) and 86 (51.5%) out of 167 eligible cases, respectively. New renal scars appeared in 46.5% of patients. Resolution or downgrading of VUR did not correlate with age at presentation, gender, type and laterality of VUR, pyelonephritis at follow-up, and presentation as prenatal hydronephrosis (P> 0.05 for all). Lack of appearance of new renal scar significantly was more frequent in-group not presented compared to those presented by prenatal hydronephrosis (67.7% compared to 16.7%, respectively; P=0.005). Resolution of VUR was significantly more common in KUUs with VUR grade V than IV (26.5% compared to 7.8%, respectively; P = 0.026). Spontaneous resolution of VUR was reported in five patients (38.5%) presented with prenatal hydronephrosis, and three cases (5.5%) by other clinical presentations (P=0.005). Conclusions: High-grade VUR persists in the majority of cases after one-three-year follow-ups and about half of patients develop new renal scars. The resolution of VUR is significantly more common in KUUs with VUR grade V than in IV. In addition, spontaneous resolution happened more frequently in cases presented by prenatal hydronephrosis than in other manifestations. Further investigations need to determine cases who are at risk for developing new renal scar and persistent VUR.

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Section: Discussionsupporting

confidence: 51%

Section: Discussionmentioning

confidence: 71%

Clinical course and new renal scar development in children with high-grade vesicoureteral reflux

Tafazoli,

Naseri

2023

Preprint

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Predictors of Renal Dysfunction in Adults with Childhood Vesicoureteral Reflux after Long-Term Follow-Up

Bundovska-Kocev¹,

Kuzmanovska²,

Selim³

et al. 2019

Open Access Maced J Med Sci

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BACKGROUND:Triad of childhood vesicoureteral reflux (VUR), urinary infection (UTI) and renal scarring might initiate potentially serious consequences that lead to renal dysfunction manifested at the second or third decade of life.AIM:To identify the risk factors predictive for renal dysfunction in adults with primary VUR after long-term follow-up.METHODS:We evaluated the records of 101 children (94.1% female, 5.9% male) at a median age of 5.2 ± 2.3 years (1-12 years), suffering from UTI and VUR. The patients were interviewed after mean 21 years from the first episodes of VUR (8 to 32 years). Renal function was determined from the estimated glomerular filtration rate (eGFR).RESULTS:Renal scarring was detected in 68.3% out of 82 patients and bilateral one in 7.3% patients. Linear regression analysis revealed that presence of proteinuria (B = -33.7, p=0.0001), the greater number of years from VUR diagnosis (B = -1.6, p = 0.002) and renal scarring (B = -14.8, p = 0.005) appeared as independent predictors of reduced global eGFRcreat. The same variables plus microalbuminuria (B = -1.0, p = 0.012) appeared as independent predictors of reduced global eGFRcreat-cys. Bilateral scarring (OR=25.5, p = 0.003) appeared as independent predictor of greater risk for CKD assessed using eGFRcreat while greater number of years from VUR diagnosis (OR = 1.7, p = 0.092), microalbuminuria (OR = 1.3, p = 0.047) and again bilateral scarring (OR = 31.3, p = 0.040) appeared as predictors of risk for CKD assessed using eGFRcreat-cys.CONCLUSION:Identification of those with an increased risk of progression to CKD should be the goal in all patients with childhood VUR. Their systematic follow-up should be till adulthood and older age.

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Clinical Course of Children and Adolescents with Primary Vesicoureteral Reflux: A retrospective study of 958 patients

Cited by 2 publications

References 17 publications

Clinical course and new renal scar development in children with high-grade vesicoureteral reflux

Clinical course and new renal scar development in children with high-grade vesicoureteral reflux

Predictors of Renal Dysfunction in Adults with Childhood Vesicoureteral Reflux after Long-Term Follow-Up

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