CONGENITAL REFLUX NEPHROPATHY - A FOLLOW-UP OF 108 CASES DIAGNOSED PERINATALLY

Objectives To determine: (i) the proportion of vesicoureteric reflux ( VUR) associated with congenital renal damage and whether it can be sev ere enough to cause renal impairment from birth; (ii) to evaluate the distribution of males and females affected: and (iiii) to describe the course of congenital damage in the first years of life. Patients and methods A total of 108 children (76 male and 32 female, M:F 2.3:1), wh ose VUR was diagnosed before any infection, were followed from birth f or a mean (range) of 4.3 (1-10) years. Renal damage was defined by ser um creatinine concentration, creatinine clearance and renal imaging (u ltrasonography and renal scintigraphy) performed within the first mont h of life and periodically thereafter. Results Of the 108 children, 58 had bilateral and 50 unilateral reflux (total number of refluxing uni ts, 166). High-grade VUR (grade greater than or equal to 4) was found in 96 (58%) refluxing renal units (RRUs). Males had a prevalence of bi lateral severe (greater than or equal to grade 4) reflux (M:F 5.2:1), while in those with unilateral VUR, the M:F ratio was 1.5:1. At birth, mild to moderate damage was present in 56 (36%) RRUs and only associa ted with VUR of grade greater than or equal to 3, Bilateral reflux of grade greater than or equal to 4 was associated with congenital modera te/severe renal failure in nine neonates (seven males), In infants wit h grade greater than or equal to 4 VUR who underwent surgical correcti on, VUR resolved in 92% of cases, In infants with VUR of grade greater than or equal to 4 followed medically, the reflux spontaneously resol ved in 42% and ameliorated in 16% after 18 months, Serial renal scans during the follow-up showed no progression of renal damage. Conclusion s VUR diagnosed at birth on prenatal ultrasonography is associated wit h congenital damage, with males affected more often than females, The damage involves both kidneys in a consistent proportion and is an impo rtant cause of chronic renal impairment from birth. It does not progre ss in the first years of life if infections are prevented, It is sugge sted that males with this condition may constitute a major group at ri sk of developing chronic renal failure in later life.