LONG-TERM FOLLOW-UP TO DETERMINE THE PROGNOSTIC VALUE OF IMAGING AFTER URINARY-TRACT INFECTIONS .1. REFLUX

In 3646 children confirmed urinary prevalence of vesicoureteric reflux presentation was correlated with progressive renal damage during foll ow up of not less than two and up to 16 years. Reflux was not demonstr ated either at presentation or at any subsequent time in almost one ha lf of the children who suffered progressive renal damage and was not a risk factor for progressive renal damage in boys under 1 year. It was an important risk factor in boys over 1 year and in girls of any age. The risk of progressive renal damage in children in whom micturating cystourethrography (MCU) did not reveal vesicoureteric reflux was subs tantially greater than in those whose indirect isotope voiding study ( IVS) did not show reflux. The risk of deterioration for those in whom reflux was demonstrated was similar for both techniques. This discrepa ncy indicates an appreciably higher false negative rate for the MCU th an the IVS. Dilatation of the renal pelvis detected by ultrasound was associated with a significantly increased risk of progressive damage o nly when associated with reflux, but most children with progressive da mage did not have a dilated collecting system at presentation.