Sjöström Sofia, Jodal Ulf, Sixt Rune, Bachelard Marc, Sillén Ulla
Department of Surgery, Queen Silvia Children's Hospital, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
J Urol. 2009 May;181(5):2277-83. doi: 10.1016/j.juro.2009.01.051. Epub 2009 Mar 19.
We sought to study renal abnormality and renal function through time in infants with high grade vesicoureteral reflux.
This prospective observational study included 115 infants (80 boys and 35 girls) younger than 1 year with grade III to V vesicoureteral reflux. The diagnosis was made after prenatal ultrasound in 26% of the patients and after urinary tract infection in 71%. Patients were followed by renal scintigraphy, 51chromium edetic acid clearance and video cystometry. Median followup was 62 months.
Renal abnormality, which was found in 90% of the children at followup, was generalized in 71% and focal in 29%. The abnormality was bilateral in 28% of the affected patients. Total glomerular filtration rate was less than 80% of expected in 30% of the patients. Single kidney function was less than 40% of expected total glomerular filtration rate in 71% of the patients. Renal status (parenchymal abnormality and function) remained unchanged through time in 84 of 108 available cases (78%), improved in 5 (5%) and deteriorated in 19 (18%). Predictive factors for deterioration were recurrent febrile urinary tract infection, bilateral abnormality and reduced total glomerular filtration rate. Deteriorated renal status was more common in cases diagnosed prenatally than in those detected after urinary tract infection.
Among these infants with high grade vesicoureteral reflux renal abnormality was frequent and was associated with subnormal filtration of one of the kidneys. Decreased total glomerular filtration rate was seen in about a third of the patients. Overall deterioration of renal status was seen in only a fifth of the patients. Infection control seems to be an important factor to minimize the risk.
我们试图通过对患有重度膀胱输尿管反流的婴儿进行长期观察，来研究肾脏异常情况及肾功能。
这项前瞻性观察研究纳入了115名年龄小于1岁、患有III至V级膀胱输尿管反流的婴儿（80名男孩和35名女孩）。26%的患者在产前超声检查后确诊，71%的患者在尿路感染后确诊。对患者进行肾脏闪烁扫描、51铬依地酸清除率测定及膀胱造影检查。中位随访时间为62个月。
随访时，90%的儿童发现有肾脏异常，其中71%为广泛性异常，29%为局灶性异常。28%的患病患者为双侧异常。30%的患者总肾小球滤过率低于预期的80%。71%的患者单肾肾功能低于预期总肾小球滤过率的40%。在108例可获得病例中，84例（78%）的肾脏状况（实质异常及功能）随时间保持不变，5例（5%）有所改善，19例（18%）恶化。肾功能恶化的预测因素为反复发热性尿路感染、双侧异常及总肾小球滤过率降低。产前诊断的病例中肾功能恶化情况比尿路感染后诊断的病例更常见。
在这些患有重度膀胱输尿管反流的婴儿中，肾脏异常很常见，且与一侧肾脏滤过功能异常有关。约三分之一的患者出现总肾小球滤过率降低。仅五分之一的患者出现肾功能整体恶化。控制感染似乎是降低风险的一个重要因素。
