Primary vesicoureteral reflux detected in neonates with a history of fetal renal pelvis dilatation: A prospective clinical and imaging study

• Published in: The Journal of pediatrics Vol. 148; no. 2; pp. 222 - 227
• Main Authors: Ismaili, Khalid, Hall, Michelle, Piepsz, Amy, Wissing, Karl M., Collier, Frank, Schulman, Claude, Avni, Fred E.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2006; Elsevier
• Subjects: Anti-Infective Agents, Urinary - therapeutic use; Antibiotic Prophylaxis; Biological and medical sciences; Chelating Agents; Chromium Radioisotopes - blood; Edetic Acid; Female; Follow-Up Studies; General aspects; Glomerular Filtration Rate; Humans; Infant; Infant, Newborn; Kidney Pelvis - abnormalities; Kidney Pelvis - diagnostic imaging; Male; Medical sciences; Nephrology. Urinary tract diseases; Pregnancy; Prospective Studies; Radionuclide Imaging; Radiopharmaceuticals; Recovery of Function; Severity of Illness Index; Technetium Tc 99m Mertiatide; Trimethoprim - therapeutic use; Ultrasonography, Prenatal; Urinary Bladder - diagnostic imaging; Urinary system involvement in other diseases. Miscellaneous; Urinary Tract Infections - etiology; Urinary Tract Infections - prevention & control; Urinary tract. Prostate gland; Vesico-Ureteral Reflux - complications; Vesico-Ureteral Reflux - diagnosis; Vesico-Ureteral Reflux - surgery; GFR; VUR; VCUG; UTI; US; AP; SKGFR; Human; Pediatrics; Urinary system disease; Renal pelvis; Urinary tract disease; Pregnancy; Prospective; Symptomatology; Newborn; Dilatation; Vesicoureteral reflux; Primary; Fetus; Medical imagery; Bladder disease; Antecedent
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2005.09.037

To assess the clinical outcome and imaging features of neonatal primary vesicoureteral reflux (VUR). We prospectively followed 43 infants with primary VUR identified from among a cohort of 497 infants with fetal renal pelvis dilatation. Postnatal renal ultrasound (US) examinations were performed at 5 days and 1, 3, 6, 12, and 24 months of life. Voiding cystourethrography was performed in the neonatal period and repeated at 12 and 24 months when VUR was persistent. Two radioisotopic examinations, including a 99mTc-MAG3 renogram and a plasma clearance of Cr-51 EDTA, were performed in all children with high-grade reflux. The incidence of primary VUR in our study group was 9%. Among the 43 patients followed, 11 (26%) had high-grade (IV-V) VUR and 32 (74%) had low-grade VUR. Resolution of reflux occurred in 2 of 11 (18%) patients with high-grade VUR and in 29 of 32 (90.6%) patients with low-grade VUR at age 2 years ( P < .001). At age 2 years, 91% of the low-grade refluxing kidneys were normal on US, compared with only 35% of the high-grade refluxing kidneys. Split renal function was within normal range and single-kidney GFR was significantly increased in 13 of the 17 high-grade refluxing kidneys during follow-up. Furthermore, a strong association between dysplasia on US and poor renal function outcome was found. In most infants with VUR, the reflux is of low grade and resolves rapidly. In those children with high-grade VUR, spontaneous resolution is rare at age 2 years, but persistent reflux rarely impairs the maturation of renal function.