Childhood reflux and urinary infection: a follow-up of 10-41 years in 226 adults

To ascertain the outcome of childhood vesicoureteric reflux (VUR), 226 adul ts (37 males), mean age 27 years, were studied after 10-35 years, extended to 41 years by: postal questionnaire in 161. At presentation (mean age 5 ye ars) all had VUR (grade III-V in 68) and urinary tract infection (UTI); the re was renal scarring in 85 (acquired before referral in 11 and during foll ow-up in 1), hypertension in 6 and impaired renal function in 5. They were managed and followed prospectively by one paediatrician; 63% of these child ren remained free from Un, VUR persisted in 63 and had resolved in 69% of 1 93 children managed medically. At follow-up, 61% of adults had remained fre e from infection; 17 adults had hypertension and/or raised plasma creatinin e, 16 with scarred kidneys. Their deterioration was predictable because of scar type, blood pressure or plasma creatinine levels in childhood. No new scars developed after puberty. Renal growth rates were unaffected by initia l severity or persistence of VUR. On the later questionnaire, 9 further adu lts, mean age 38 years, had moderate hypertension. The adults with complica tions were those with extensive renal scarring and/or at least borderline h ypertension in childhood. Those with VUR, but no scarring, and managed care fully in childhood, did not suffer serious consequences as adults. There is a need for early recognition and treatment of children with VUR and UTI to limit scar development.