Arant B S
Department of Pediatrics, University of Texas, Southwestern Medical Center, Dallas.
J Urol. 1992 Nov;148(5 Pt 2):1683-7. doi: 10.1016/s0022-5347(17)37002-7.
Mild and moderate vesicoureteral reflux is expected to resolve spontaneously in most children treated medically; however, maximum benefit or minimum risk of such therapy has not been defined. A prospective 5-year followup study of infants and children younger than 5 years at entry with primary vesicoureteral reflux (grades I to III/V) and radiographically normal kidneys after the first recognized urinary tract infection was initiated in 1984. A total of 113 patients was entered from 5 centers and 61% of the patients were less than 2 years old. Vesicoureteral reflux was unilateral in 65 cases (58%) and bilateral in 48 (42%). Of the 226 renal units reflux was grade IV in 4 (2%), III in 51 (22%), II in 81 (36%) and I in 25 (11%), and 65 (29%) had no vesicoureteral reflux. Data on 59 patients who have completed the protocol were analyzed for this report. Breakthrough urinary tract infection occurred in 20 patients. Of the 84 ureters with vesicoureteral reflux at diagnosis reflux resolved in 67%, and it was of lower grade in 22%, same grade in 8% and higher grade in 2%. Grade I vesicoureteral reflux resolved in 82%, grade II in 80% and grade III in 46% of the ureters. Resolution was better when vesicoureteral reflux was unilateral left (74%) than unilateral right (46%) or bilateral (60%). Renal scarring occurred, on average, in 10% of the kidneys without known vesicoureteral reflux or exposed only to nondilating (grades I and II) reflux and in 28% of those with dilating (grade III) reflux. Thirteen cases had breakthrough urinary tract infection but only after the scar was noted in 5. We conclude that under good medical management during 5 years of followup, even mild and moderate vesicoureteral reflux can be associated with renal injury.
大多数接受药物治疗的儿童，其轻度和中度膀胱输尿管反流有望自然消退；然而，这种治疗的最大益处或最小风险尚未明确。1984年启动了一项对初发膀胱输尿管反流（I至III/V级）且首次确诊尿路感染后肾脏影像学正常的5岁及以下婴幼儿和儿童进行的前瞻性5年随访研究。共有113例患者来自5个中心，61%的患者年龄小于2岁。膀胱输尿管反流单侧65例（58%），双侧48例（42%）。226个肾单位中，反流为IV级的4个（2%），III级的51个（22%），II级的81个（36%），I级的25个（11%），65个（29%）无膀胱输尿管反流。本报告分析了59例完成方案的患者的数据。20例患者发生了突破性尿路感染。诊断时84条存在膀胱输尿管反流的输尿管中，67%反流消退，22%反流程度降低，8%反流程度不变，2%反流程度加重。I级膀胱输尿管反流的输尿管82%消退，II级的80%，III级的46%。膀胱输尿管反流为左侧单侧时反流消退情况（74%）优于右侧单侧（46%）或双侧（60%）。在无已知膀胱输尿管反流或仅暴露于非扩张性（I级和II级）反流的肾脏中，平均10%出现肾瘢痕，而在有扩张性（III级）反流的肾脏中，这一比例为28%。13例发生突破性尿路感染，但其中5例是在发现瘢痕后才出现。我们得出结论，在5年随访期间的良好药物管理下，即使是轻度和中度膀胱输尿管反流也可能与肾损伤相关。
