Primary vesicoureteral reflux in children under one year of age: the case for conservative management?

The natural course of reflux nephropathy was evaluated in children who have been diagnosed for primary vesicoureteral reflux already during the first year of life. The retrospective study in 103 patients (163 refluxive renal units) revealed that 80% of all children in this age group were boys. Scarring at the time of diagnosis was evident in 29% of the cases, compared to a rate of 20% in our whole reflux population. New scarring occurred in 17 patients (18%): 63% of the children had high grade refluxes (IV and V). The rate of spontaneous resolutions was 61% and even grade V refluxes showed a spontaneous cessation in 40% of the cases. These data indicate a high overall spontaneous cure rate in young children, but underline the importance of selecting those patients with already scarred kidneys and recurrent urinary tract infections for an early operation since they are not likely to show a spontaneous resolution of reflux.