Smellie J M, Prescod N P, Shaw P J, Risdon R A, Bryant T N
Department of Paediatrics, University College London Medical School and Hospitals, UK.
Pediatr Nephrol. 1998 Nov;12(9):727-36. doi: 10.1007/s004670050535.
To ascertain the outcome of childhood vesicoureteric reflux (VUR), 226 adults (37 males), mean age 27 years, were studied after 10-35 years, extended to 41 years by postal questionnaire in 161. At presentation (mean age 5 years) all had VUR (grade III-V in 68) and urinary tract infection (UTI); there was renal scarring in 85 (acquired before referral in 11 and during follow-up in 1), hypertension in 6 and impaired renal function in 5. They were managed and followed prospectively by one paediatrician; 63% of these children remained free from UTI; VUR persisted in 63 and had resolved in 69% of 193 children managed medically. At follow-up, 61% of adults had remained free from infection; 17 adults had hypertension and/or raised plasma creatinine, 16 with scarred kidneys. Their deterioration was predictable because of scar type, blood pressure or plasma creatinine levels in childhood. No new scars developed after puberty. Renal growth rates were unaffected by initial severity or persistence of VUR. On the later questionnaire, 9 further adults, mean age 38 years, had moderate hypertension. The adults with complications were those with extensive renal scarring and/or at least borderline hypertension in childhood. Those with VUR, but no scarring, and managed carefully in childhood, did not suffer serious consequences as adults. There is a need for early recognition and treatment of children with VUR and UTI to limit scar development.
为了确定儿童膀胱输尿管反流（VUR）的转归情况，对226名成年人（37名男性）进行了研究，他们的平均年龄为27岁，随访时间为10至35年，其中161人通过邮寄问卷调查将随访时间延长至41年。初诊时（平均年龄5岁），所有患者均有VUR（68例为III - V级）和尿路感染（UTI）；85例有肾瘢痕形成（11例在转诊前获得，1例在随访期间获得），6例有高血压，5例有肾功能损害。由一名儿科医生对他们进行前瞻性管理和随访；这些儿童中有63%未再发生UTI；63例VUR持续存在，在193例接受药物治疗的儿童中，69%的VUR已缓解。随访时，61%的成年人未再发生感染；17名成年人有高血压和/或血肌酐升高，其中16人有瘢痕肾。由于儿童时期的瘢痕类型、血压或血肌酐水平，他们的病情恶化是可预测的。青春期后未出现新的瘢痕。肾脏生长速率不受VUR初始严重程度或持续时间的影响。在后来的问卷调查中，另有9名平均年龄为38岁的成年人患有中度高血压。有并发症的成年人是那些在儿童时期有广泛肾瘢痕形成和/或至少临界高血压的人。那些有VUR但无瘢痕形成且在儿童时期得到精心管理的人，成年后未出现严重后果。需要早期识别和治疗患有VUR和UTI的儿童，以限制瘢痕形成。
