The Swedish Reflux Trial in Children: IV. Renal Damage
Purpose
We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group.
Materials and Methods
Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III–IV reflux. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. Febrile urinary tract infections were recorded during followup. Data analysis was done by the intent to treat principle.
Results
New renal damage in a previously unscarred area was seen in 13 girls and 2 boys. Eight of the 13 girls were on surveillance, 5 received endoscopic therapy and none were on prophylaxis (p = 0.0155). New damage was more common in children with than without febrile recurrence (11 of 49 or 22% vs 4 of 152 or 3%, p <0.0001).
Conclusions
In boys the rate of new renal damage was low. It was significantly higher in girls and most common in the control surveillance group. There was also a strong association between recurrent febrile UTIs and new renal damage in girls.
Key Words: kidney, urinary tract infections, vesico-ureteral reflux, cicatrix, fever
Abbreviations and Acronyms: DMSA, 99mtechnetium dimercapto-succinic acid, RCT, randomized, controlled trial, UTI, urinary tract infection, VCU, voiding cystourethrography, VUR, vesicoureteral reflux
Supplementary material for this article can be obtained at http://hdl.handle.net/2077/22171.
Study received approval from research ethics committees at participating centers.
Supported by grants from the West Region, Sweden and Futurum, Jönköping County Council, Sweden.
PII: S0022-5347(10)00147-3
doi:10.1016/j.juro.2010.01.060
© 2010 American Urological Association Education and Research, Inc. Published by Elsevier Inc All rights reserved.
