ISSN:
1437-9813
Keywords:
Vesicoureteric reflux
;
Reflux nephropathy
;
Antireflux surgery
;
Vesicorenal reflux
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Notes:
Abstract It is well known that the most serious complication of primary vesicoureteric reflux is chronic atrophic pyelonephritis or reflux nephropathy. The main goal in the management of vesicorenal reflux (VRR) is the prevention of progressive renal damage. The elimination of reflux and the eradication of infection are fundamental in order to achieve this goal. The authors performed a retrospective study in 146 pediatric patients operated upon by ureteral reimplantation for primary VRR; 78 operations were unilateral and 68 bilateral, for a total of 214 reimplanted ureters. The mean age at the time of operation was 4.8 years; the mean age at the time of the study was 15.8 years, and the average postoperative observation period was 13.5 years. The study included pre- and postoperative urine analysis and determinations of blood pressure, renal scarring and parenchymal growth, and evolution of renal function. The study showed that: (1) urinary concentrating ability in bilateral high-degree VRR (64 patients) remained reduced in a relatively high percentage of patients; (2) there was significant improvement (from 40.7% to 17.9%) in proteinuria that was related to favorable evolution of renal function (z = 4.152; P 〈0.01); (3) the frequency of acute pyelonephritis decreased from 41.4 to 3.4%, and only 20% of the patients had episodes of afebrile pathologic bacteriuria in the postoperative period (z = 7.647; P 〈0.01); (4) more than 15% of the patients were hypertensive (10.3%) or at risk for hypertension, having a high peripheral plasma renin activity (5.2%); (5) some renal scarring developed despite successful antireflux surgery, and usually parenchymal growth resumed; in about 6% of the renal units a further decrease in renal size occurred; and (6) renal function generally improved after successful surgery (z = 4.115; P 〈0.01). This favorable evolution was much more evident in patients operated upon in the first 2–3 years of life (z = 3.885; P 〈0.01). However, when the renal function was already severely compromised, an antireflux operation had little or no effect on the inexorable decline in renal function.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/BF00176117
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