Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial

Background Nephropathy associated with vesicoureteric reflux (VUR) and urin ary tract infection can result in end-stage renal failure, hypertension, or both. Whether long-term VUR contributes to these outcomes is unknown. We c ompared, in a randomised trial. medical with surgical management of childre n with bilateral severe VUR and bilateral nephropathy. Methods We stratified by age and glomerular filtration rate (GFR) 25 boys a nd 27 girls aged 1-12 years and randomly assigned them to medical or surgic al management. At enrolment and 4 years' follow-up we estimated GFR from th e plasma clearance of Cr-51-labelled edetic acid (EDTA), and did intravenou s urography. We also did a metastable Tc-99m-labelled dimercaptosuccinic ac id (DMSA) assay and contrast cystography. The change in GFR at 4 years, exp ressed as a percentage change between enrolment and 4 years, was available for 26 of 27 patients in the medical and 24 of 25 in the surgical group. We assessed GFR in 48 patients 10 years after enrolment. Findings Mean GFR at enrolment was 72.4 mL/min per 1.73 m(2) (SD 24.1) in t he medical and 71.7 mL/min per 1.73 m(2) (22.6) in the surgical group. The mean percentage change in Gm at 4 years was -2.4% (SE 4.5) versus 4.7% (5.0 ) in the medical and surgical groups, respectively. The difference in chang e in GFR at 4 years between the two groups was not significant(7.1%, 95% CI -6.4% to 20.6%). Interpretation Our data do not lend support to the view that the outcome fo r renal function is improved by surgical correction of VUR in children with bilateral disease.