Features of primary vesicoureteral reflux and renal damage in children at a single institution in Brazil from 1969 to 1999

• Published in: International urology and nephrology 2003, Vol.35 (2), p.161-168
• Main Authors: Silva, José Maria Penido, Diniz, José Silvério S, Oliveira, Eduardo A, Cardoso, Luís Sérgio Bahia, Marino, Viviane S P, Pimenta, Mariana R, Matos, Carolina C, Vieira, Samana B
• Format: Article
• Language: English
• Subjects: Adolescent; Age Distribution; Brazil; Child; Child, Preschool; Female; Health Facilities; Humans; Infant; Kidney Diseases - diagnosis; Kidney Diseases - epidemiology; Kidney Diseases - etiology; Male; Retrospective Studies; Sex Distribution; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - diagnosis; Vesico-Ureteral Reflux - epidemiology
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1023/B:UROL.0000020293.62258.11

The purpose of the study was to evaluate the clinical/radiological features of patients with primary vesicoureteral reflux (VUR) admitted to a single institution from 1969 to 1999. The patients' records were retrospectively reviewed and the following clinical data obtained at admission were analyzed: age, gender, race, date of entry, previous symptoms, weight, height, blood pressure, and serum renal function. The renal imaging tests at baseline were also retrospectively analyzed including voiding cystourethrography, excretory urography, DMSA scan, and ultrasonography. For statistical analysis, reflux was classified into two categories: (1) mild/moderate (grade I/II/III) and (2) severe (grade IV/IV). Renal damage was categorized according to the following classification: (I) mild, focal damage; (II) moderate, more extensive scars, and (III) severe, generalized damage or shrunken kidney. The odds ratio (OR) and the respective confidence interval (95%CI) were calculated to compare the difference in risk between groups. A total of 461 patients were enrolled in the protocol. There was a predominance of female gender (71%) and white race (73%). Mean age at VUR diagnosis was 2.8 y and 93% of the patients had urinary infection before admission. Bilateral reflux was diagnosed in 249 (54%) children, for a total of 710 renal units for study. The distribution of reflux grade was as follows: grade I (7%); II (36%); III (26%); IV (23%), and V (8%). Of the 450 children investigated, 180 (40%) presented with renal damage, for a total of 234 (26%) units with renal scars. Renal damage was associated with the following factors: Diagnosis after 2 y of age (OR = 1.5, 95%CI = 1.08-2.1, p = 0.01), severe degree of reflux (OR = 6, 95%CI = 4-9, p < 0.001). There was a significant risk of severe renal damage for male gender (OR = 1.9, IC95% = 1.3-2.1, p = 0.001). There was a predominance of renal damage in children diagnosed above 2 y and with a high degree of reflux. Severe renal damage was associated with male gender.