Unilateral vesicoureteric reflux: Low prevalence of contralateral renal damage

Objective: We assessed the risk for the occurrence of renal damage in child ren with vesicoureteric reflux (VUR). Study design: We reviewed the records of 187 consecutive children, aged 3.8 +/- (SD) 2.8 years, with unilateral primary VUR diagnosed after urinary tr act infection (UTI). Dimercaptosuccinic acid renal scintigraphy was perform ed 4 to 6 months after the last UTI. Three patterns of renal damage were id entified: global reduction (GR) of renal radionuclide uptake (20% to 40% of relative uptake), focal defects (FD) in uptake, and shrunken (relative upt ake <20%) kidney (SK). We assumed that in these subjects FD indicated postp yelonephritic damage and that GR indicated congenital renal damage. Results: Scintigraphic renal damage of any type was present in 36.9% of the refluxing and in 3.2% of the nonrefluxing kidneys (odds ratio [OR], 17.6; 95% CI, 7.4 to 41.9). FD were present in 15.5% and 2.7% (OR, 6.7; CI, 2.5-1 7.6), GR in 19% and 0.5% (OR, 44.3; CI, 6.1 to 327.2), and SK in 6.9% and 0 %, respectively. Patients with severe VUR showed a higher probability of re nal damage than those with nonsevere VU R. Conclusions: In children with UTI and VUR, the refluxing kidney is most at risk of both congenital and acquired renal damage, and this risk increases with severity of reflux.