Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children

For the comparison of long-term outcome of the management of medical or surgical treatment of children with severe vesicoureteral reflux (VUR), children aged or=70 ml/min per 1.73 m2 body surface area were recruited, and 306 were randomly allocated to receive antimicrobial prophylaxis or ureteral re...

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Published in:Pediatric nephrology (Berlin, West) West), 2006-06, Vol.21 (6), p.785-792
Main Authors: Jodal, Ulf, Smellie, Jean M, Lax, Hildegard, Hoyer, Peter F
Format: Article
Language:English
Subjects:
Anti-Infective Agents - therapeutic use
Child
Child, Preschool
Female
Glomerular Filtration Rate
Humans
Hypertension
Hypertension - diagnosis
Infant
Kidney - diagnostic imaging
Kidney - physiopathology
Kidney/physiopathology/radiography
Kidneys
Male
MEDICAL AND HEALTH SCIENCES
MEDICIN OCH HÄLSOVETENSKAP
Preschool
Randomized Controlled Trials
Randomized Controlled Trials as Topic
Recurrence/prevention & control
Replantation
Scars
Secondary Prevention
Treatment Outcome
Urinary tract diseases
Urinary tract infections
Urinary Tract Infections - prevention & control
Urogenital system
Urography
Vesico-Ureteral Reflux - drug therapy
Vesico-Ureteral Reflux - surgery
Vesico-Ureteral Reflux - therapy
Vesico-Ureteral Reflux/drug therapy/surgery/therapy
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Summary:For the comparison of long-term outcome of the management of medical or surgical treatment of children with severe vesicoureteral reflux (VUR), children aged or=70 ml/min per 1.73 m2 body surface area were recruited, and 306 were randomly allocated to receive antimicrobial prophylaxis or ureteral reimplantation. Primary endpoints were new renal scars and renal growth. Follow up, originally planned for 5 years, was extended to 10 years for 252 children, 223 of whom had follow-up imaging. Up to 5 years, 40 new urographic scars (medical 19, surgical 21) were seen. Between 5 years and 10 years, only two further scars were observed. Renal growth and UTI recurrence rate were similar, except that medically treated patients had more febrile infections. There was no difference in somatic growth, radionuclide imaging or renal function. A GFR or=70 ml/min per 1.73 m2 progressed remarkably well under either medical or surgical management, emphasizing the importance of continued supervision and the entry level of renal function.
ISSN:0931-041X
1432-198X
DOI:10.1007/s00467-006-0063-0