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KMID : 0811820140180010029
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Journal of Korean Society of Pediatric Nephrology
2014 Volume.18 No. 1 p.29 ~ p.35
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Clinical Characteristics and Prognostic Factors of Vesicoureteral Reflux
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Kim Wun-Kon
Ha Tae-Sun
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Abstract
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Introduction: Persistent vesicoureteral reflux (VUR), a major cause of urinarytract infection (UTI) in children, can result in serious renal complications, suchas reflux nephropathy and chronic renal failure. We evaluated the clinical characteristicsand prognostic factors of VUR.
Methods: From December 1993 to May 2011, we examined 117 children withvesicoureteral reflux who were admitted to the Department of Pediatrics andUrology, Chungbuk National University hospital for a UTI. The patients weremanaged medically or surgically.
Results: Male patients had a slightly higher prevalence of VUR than femalepatients (55%). The degrees of the 161 refluxing ureters, as classified by the InternationalReflux Study Committee, were as follows: grade I, 15 ureters; grade II,32 ureters; grade III, 54 ureters; grade IV, 26 ureters; grade V, 34 ureters. Onehundred and sixty-one renal units (115 cases) underwent a 99m TC-DMSA renalscan, and 62% showed abnormal findings. The incidence of renal cortical defectsshowed a direct correlation with the severity of VUR. Ninety-four refluxingureters were followed up medically, and 66 ureters (67%) either disappeared orimproved. However, 9 refluxing ureters persisted. The spontaneous resolutionrate of VUR seemed to be higher in younger patients with lower grades of reflux,and without renal cortical defects. Sixty-seven refluxing ureters (41%) weretreated surgically, 62 refluxing ureters (92%) disappeared, and 5 refluxing ureters(8%) persisted.
Conclusion: The incidence of renal cortical defects in patients with UTIs was62% (in a 99m TC-DMSA renal scan), and showed a direct correlation with theseverity of VUR. The spontaneous resolution rate seemed to be lower in thepatients with higher grades of VUR, older age (over 4 years old) and diffuse renalcortical defects.
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KEYWORD
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Vesicoureteral reflux, Renal cortical defect, Spontaneous resolution, Urinary tract infection
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