Does treatment of vesicoureteric reflux in childhood prevent end-stage renal disease attributable to reflux nephropathy?

Objective. It is believed that end-stage renal disease (ESRD) attributable to reflux nephropathy is preventable by the active treatment of vesicourete ric reflux in childhood with long-term antibiotics and ureteric reimplantat ion surgery. We aimed to test this belief. Methodology. The Australia and New Zealand Dialysis and Transplant Registry of new patients 5 to 44 years of age treated for ESRD between 1971 and 199 8, categorized by age and primary renal disease, was used to analyze the ag e-specific incidences of ESRD attributable to reflux nephropathy using a be fore-after study design. The early 1960s were regarded as the introduction period for the active treatment of childhood vesicoureteric reflux. A time- delay in treatment effect was expected. Patients with ESRD attributable to other causes were used as a comparative group. Results. The incidence of ESRD attributable to reflux nephropathy and nonre flux nephropathy has increased. For reflux nephropathy, the rate of change was significantly associated with age, with a downward trend in incidence w ith decreasing age suggesting a minor treatment effect. This trend was no l onger evident when adjustment was made for changing diagnostic practices. A n opposite trend was observed for the nonreflux nephropathy group, who demo nstrated an upward trend in incidence with decreasing age. Conclusions. Treatment of children with vesicoureteric reflux has not been accompanied by the hoped-for reduction in the incidence of ESRD attributabl e to reflux nephropathy. A randomized trial with a control (no-treatment) a rm is required to appropriately assess the medical belief that long-term an tibiotics and surgery improve the natural history of vesicoureteric reflux.