Calisti A, Perrotta M L, Menghini M L, Miele G
Az. Osp. S. Camillo Forlanini Roma.
Pediatr Med Chir. 2002 Jul-Aug;24(4):279-83.
Ultrasonographic and radionuclide imaging of kidney in presence of major vesicoureteric reflux, diagnosed in the first months of life, reflects a congenital anomaly of development of ureteric bud and metanephric blastema, more than a parenchymal damage secondary to superimposed infections. These lesions are mainly observed in male infants affected by reflux and referred on the basis of a prenatal diagnosis. The impact of therapy on these kidneys is still debated.
Among 273 pediatric patients with VUR observed between 1991 and 2000, 48 cases have been selected where a reflux grade III or greater had been diagnosed within the first six months of life. Cause of admission was prenatal diagnosis in 29 cases and recurrent infection in 19. Reflux was bilateral in 30 patients. Cases of VUR associated to other urological or neurological anomalies were excluded. A complete ultrasonographic, cystographic and radionuclide study was performed in all patients included in the present study within the fourth month of life. Mean Follow up lasted 17 months. Renal damage was graded by ultrasonography and DMSA renal scan on the basis or of a reduction in total kidney size and a poor radionuclide uptake either of an altered renal profile associated to focal defects of uptake.
Resolution of reflux within the mean follow up period, was observed in 16 patients, even with high grade VUR, whenever major renal lesions were absent or focal. When severe renal damage was initially demonstrated the expectancy of reduction or resolution of VUR was significantly reduced and surgical option was considered.
Among patients with major VUR diagnosed in the first months of life, early renal status affects prognosis more than the severity of reflux.
