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THE SWEDISH INFANT HIGH GRADE REFLUX TRIAL - UTI AND RENAL DAMAGE
Per BRANDSTRÖM
1
, Josefin NORDENSTRÖM
2
, Sofia SJÖSTRÖM
2
, Rune SIXT
3
and Ulla SILLÉN
2
1) Queen Silvia Children's Hospital, Department of Pediatrics, Gothenburg, SWEDEN - 2) Queen Silvia Children's
Hospital, Department of Pediatric Urology and Surgery, Gothenburg, SWEDEN - 3) Queen Silvia Children's Hospital,
Department of Pediatric Clinical Physiology, Gothenburg, SWEDEN
PURPOSE
Endoscopic injection is an established treatment option for vesicoureteral reflux (VUR) in children. Does endoscopic
treatment of VUR grade 4-5 in infants reduce the risk of UTI recurrence and renal scarring?
MATERIAL AND METHODS
This randomized, controlled, multicenter, 1-year follow-up trial, enrolled 77 infants (22 girls, 55 boys) <(less than) 8
months of age with VUR grade 4-5(n=30/n=47), bilateral VUR in 52(68%). 39 were randomized to continuous antibiotic
prophylaxis (CAP) and 38 to endoscopic treatment (and prophylaxis until resolution). Voiding cystourethrogram and
DMSA-scintigraphy/MAG-3-renography were performed at study entry and after 1 year. Parenchymal defects were seen
in 67(87%) children at entry, 28(36%) categorized as severe, severity more pronounced in boys. At follow-up new
scars, worsening of damaged kidneys and symptomatic UTIs (≥38.5°C=febrile) were reported.
RESULTS
There were 27 recurrent febrile UTIs in 6(16%) children in the endoscopy group and in 10(26%) in the CAP group
(p=0.43), in 8(36%) girls and 8(15%) boys (p=0.074).
New renal scars were detected in 1(3%) child in the endoscopic group and in 3(8%) in the CAP group p=0.64),
deterioration in 3(8%) and 5(14%) respectively (p=0.74). New scars were seen in 3(14%) girls and 1(2%) boy
(p=0.13), deterioration in 4(19%) girls and 4(8%) boys (p=0.32).
There was a weak correlation between number of febrile UTIs and VUR-grade at follow-up (Spearman correlation
coefficient 0.26). There was a tendency to more deterioration in children with several febrile recurrences (p=0.067). In
5 of the 8 children with deterioration, as in 2 of the 4 with new scars, there was no febrile UTI documented.
CONCLUSIONS
In this high-risk group of children, 87% of them with established renal defects in infancy, the lower risk of febrile
recurrences and renal scarring seen after endoscopic treatment compared to CAP was not significant, probably due to
the small study population and short observation. Renal scarring can occur in the absence of UTI.