TY - JOUR
T1 - Primary vesicoureteral reflux detected in neonates with a history of fetal renal pelvis dilatation
T2 - a prospective clinical and imaging study
AU - Ismaili, Khalid
AU - Hall, Michelle
AU - Piepsz, Amy
AU - Wissing, Karl M
AU - Collier, Frank
AU - Schulman, Claude
AU - Avni, Fred E
PY - 2006/2
Y1 - 2006/2
N2 - OBJECTIVE: To assess the clinical outcome and imaging features of neonatal primary vesicoureteral reflux (VUR).STUDY DESIGN: 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.RESULTS: 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.CONCLUSIONS: 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.
AB - OBJECTIVE: To assess the clinical outcome and imaging features of neonatal primary vesicoureteral reflux (VUR).STUDY DESIGN: 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.RESULTS: 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.CONCLUSIONS: 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.
KW - Anti-Infective Agents, Urinary
KW - Antibiotic Prophylaxis
KW - Chelating Agents
KW - Chromium Radioisotopes
KW - Edetic Acid
KW - Female
KW - Follow-Up Studies
KW - Glomerular Filtration Rate
KW - Humans
KW - Infant
KW - Infant, Newborn
KW - Kidney Pelvis
KW - Male
KW - Pregnancy
KW - Prospective Studies
KW - Radionuclide Imaging
KW - Radiopharmaceuticals
KW - Recovery of Function
KW - Severity of Illness Index
KW - Technetium Tc 99m Mertiatide
KW - Trimethoprim
KW - Ultrasonography, Prenatal
KW - Urinary Bladder
KW - Urinary Tract Infections
KW - Vesico-Ureteral Reflux
KW - Journal Article
KW - Research Support, Non-U.S. Gov't
U2 - 10.1016/j.jpeds.2005.09.037
DO - 10.1016/j.jpeds.2005.09.037
M3 - Article
C2 - 16492433
VL - 148
SP - 222
EP - 227
JO - Journal of Pediatrics
JF - Journal of Pediatrics
SN - 0022-3476
IS - 2
ER -