Abstract
Children with severe vesicoureteric reflux were allocated randomly to either operative or non-operative treatment and followed up. Altogether 161 children were observed for two years, of whom 104 were followed up for five years. Reflux was abolished in 98% of ureters reimplanted, but more than half of the patients treated non-operatively continued to show severe reflux at five years. Two patients progressed to end stage renal failure, and a further four with extensive bilateral renal scarring became hypertensive. There were no significant differences between treatment groups in the incidence of breakthrough urinary infection, renal excretory function and concentrating ability, renal growth, progression of existing renal scars, or new scar formation. Progressive scarring occurred at all ages but was significantly more common during the first two years' observation. Furthermore, new scars developed exclusively during the first two years' observation, affecting 10 children aged 2-7 at allocation. Neither treatment can claim superiority or fully protect the kidneys from further damage, and efforts must continue to be directed towards identifying those at risk before scarring develops.
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Selected References
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- Edelmann C. M., Jr, Barnett H. L., Stark H., Boichis H., Soriano J. R. A standarized test of renal concentrating capacity in children. Am J Dis Child. 1967 Dec;114(6):639–644. doi: 10.1001/archpedi.1967.02090270095009. [DOI] [PubMed] [Google Scholar]
- Eklöf O., Ringertz H. Kidney size in children. A method of assessment. Acta Radiol Diagn (Stockh) 1976 Sep;17(5A):617–625. doi: 10.1177/028418517601705a10. [DOI] [PubMed] [Google Scholar]
- Smellie J. M., Ransley P. G., Normand I. C., Prescod N., Edwards D. Development of new renal scars: a collaborative study. Br Med J (Clin Res Ed) 1985 Jun 29;290(6486):1957–1960. doi: 10.1136/bmj.290.6486.1957. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Uehling D. T. Effect of vesicoureteral reflux on concentrating ability. J Urol. 1971 Dec;106(6):947–950. doi: 10.1016/s0022-5347(17)61444-7. [DOI] [PubMed] [Google Scholar]
- Verrier Jones K., Asscher A. W., Verrier Jones E. R., Mattholie K., Leach K., Thomson G. M. Glomerular filtration rate in schoolgirls with covert bacteriuria. Br Med J (Clin Res Ed) 1982 Nov 6;285(6351):1307–1310. doi: 10.1136/bmj.285.6351.1307. [DOI] [PubMed] [Google Scholar]
- White R. H. Management of urinary tract infection. Arch Dis Child. 1987 Apr;62(4):421–427. doi: 10.1136/adc.62.4.421. [DOI] [PMC free article] [PubMed] [Google Scholar]