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S4-13
(P)
OUTCOME OF KIDNEY FUNCTION AND GENERAL STATUS IN CHILDREN TREATED
FOR PRIMARY VESICOURETERAL REFLUX DURING INFANT OVER 15 YEARS
FOLLOW-UP
Hiroyuki SATOH, Yujirou AOKI and Zenichi MATSUI
Tokyo Metropolitan Children's Medical Center, Department of Urology and Kidney Transplantation, Tokyo, JAPAN
PURPOSE
The purpose of this retrospective study was to evaluate outcome of kidney function and general status in children with
high grade vesicoureteral reflux(VUR) who were examined renal scarring and underwent surgical treatment during infant
and observed over 15 years.
MATERIAL AND METHODS
Between 1988 and 1994, 45 patients were diagnosed with high grade VUR(grade 3-5) and underwent surgical treatment
within the first year of life and systematically followed up over 15 years old. Renal scarring was evaluated by DMSA
scintigraphy at 6 months after the infection and was classified as group 0 to 3: Group 0(G0) had no parenchymal lesion.
Group 1(G1) had unilateral and bilateral single parenchymal lesion. Group 2(G2) have unilateral multiple or diffuse
parenchymal lesion with or without contralateral single parenchymal lesion. Group 3(G3) had bilateral multiple or diffuse
parenchymal lesion. Chronic renal failure(CRF) was defined as estimated glomerular filtration rate(GFR) under 60ml/min
per 1.73
m
2
body surface area.
RESULTS
Among 45 patients(41 males), 6 had no renal scar, 7 had G1 scar, 24 had G2 scar and 8 had G3 scar at initial
evaluation. GFRs(ml/min/1.73m
2
) at age 15 were 129.1±12.0 in G0, 138.5±19.6 in G1, 118.3±19.6 in G2 and
67.3±47.5 in G3. Five of 45(11.1%) had CRF and all of them were in group 3. Three of 8 patients in group 3 underwent
kidney transplantations over 10 years old.High blood pressure (HBP) was found in 16.7% of G0, 14.2% of G1, 33.3% of
group 2 and 50% of G3. Proteinuria was found in none of G0 and 1, 16.7% of G2 and 50% of G3. Urine beta-2
microglobulin/Cr level at age 1 correlate with renal scar grade. However urineN-acetyl-β-D-glucosaminidase level had no
correlation with scar grade.
CONCLUSIONS
The patients with unilateral multiple or diffuse scar and bilateral multiple or diffuse scar had high prevalence of HBP and
proteinuria. Moreover the patients with multiple bilateral renal scar had very high risk of CRF and were needed long-
term follow-up.