High Spontaneous Resolution Rates of Severe Primary Vesicoureteral Reflux and Minimal Development of New Renal Scars
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: The previous reports regarding VUR resolution were not precise due to early frequent surgical intervention. We evaluated the spontaneous resolution (SR) rate and the incidence of new renal scars in primary VUR, focusing on severe reflux. Methods: Medical records of 334 patients with primary VUR who were on medical prophylaxis without surgery for 1 to 9 years, were retrospectively reviewed. Medical prophylaxis was initiated with low-dose antibiotic prophylaxis or probiotics. Ra dioisotope cystourethrography was performed every 1 to 3 years until SR of reflux. New renal scar was evaluated with follow-up 99m Tc DMSA renal scan. Results: The SR rates decreased as VUR grades were getting higher (P=0.00). The overall and annual SR were 58.4% and 14.9%/yr in grade IV reflux and 37.5% and 9.3%/yr in grade V reflux. The median times of SR were 38 months in grade IV reflux and 66 months in grade V reflux. The probable SR rates in grade IV and V reflux were 7.8% and 8.9% in the 1st year, 46.0% and 30.8% in the 3rd year and 74.4% and 64.4% in the 5th year. The incidences of new renal scars between low to moderate reflux and severe reflux showed no significant difference (P=0.32). Conclusion: The SR rates of severe primary VUR were higher than previously re ported and most new renal scars were focal and mild.
Abstract
Purpose: The previous reports regarding VUR resolution were not precise due to early frequent surgical intervention. We evaluated the spontaneous resolution (SR) rate and the incidence of new renal scars in primary VUR, focusing on severe reflux. Methods: Medical records of 334 patients with primary VUR who were on medical prophylaxis without surgery for 1 to 9 years, were retrospectively reviewed. Medical prophylaxis was initiated with low-dose antibiotic prophylaxis or probiotics. Ra dioisotope cystourethrography was performed every 1 to 3 years until SR of reflux. New renal scar was evaluated with follow-up 99m Tc DMSA renal scan. Results: The SR rates decreased as VUR grades were getting higher (P=0.00). The overall and annual SR were 58.4% and 14.9%/yr in grade IV reflux and 37.5% and 9.3%/yr in grade V reflux. The median times of SR were 38 months in grade IV reflux and 66 months in grade V reflux. The probable SR rates in grade IV and V reflux were 7.8% and 8.9% in the 1st year, 46.0% and 30.8% in the 3rd year and 74.4% and 64.4% in the 5th year. The incidences of new renal scars between low to moderate reflux and severe reflux showed no significant difference (P=0.32). Conclusion: The SR rates of severe primary VUR were higher than previously re ported and most new renal scars were focal and mild.
참고문헌 (28)
- Tamminen-Mobius T, "Cessation of vesicoureteral reflux for 5 years in infants and children allocated to medical treatment. The International Reflux Study in Children", The Journal of Urology, 148, pp.1662~1666 (1992)
- Elder JS, "Pediatric Vesicoureteral Reflux Guidelines Panel summary report on the management of primary vesicoureteral reflux in children", The Journal of Urology, 157, pp.1846~1851 (1997)
- Kliegman R., "Vesicoureteral Reflux" (2011), Elsevier Science & Technology
- Smellie JM, "Outcome at 10 years of severe vesicoureteric reflux managed medically : Report of the International Reflux Study in Children", The Journal of Pediatrics, 139, pp.656~663 (2001)
- Schwab CW Jr., "Spontaneous resolution of vesicoureteral reflux : a 15-year perspective", The Journal of Urology, 168, pp.2594~2599 (2002)
- Silva JM, "Clinical course of 735 children and adolescents with primary vesicoureteral reflux", Pediatric Nephrology, 21, pp.981~988 (2006)
- Wildbrett P, "Spontaneous vesicoureteral reflux resolution in children : A ten-year singlecentre experience", African Journal of Paediatric Surgery : AJPS, 10, pp.9~12 (2013)
- Yeung CK, "The characteristics of primary vesico-ureteric reflux in male and female infants with pre-natal hydronephrosis", British Journal of Urology, 80, pp.319~327 (1997)
- Farhat W, "The natural history of neonatal vesicoureteral reflux associated with antenatal hydronephrosis", The Journal of Urology, 164, pp.1057~1060 (2000)
- Sjostrom S, "Spontaneous resolution of high grade infantile vesicoureteral reflux", The Journal of Urology, 172, pp.694~698 (2004)
- Marra G, "Congenital renal damage associated with primary vesicoureteral reflux detected prenatally in male infants", The Journal of Pediatrics, 124, pp.726~730 (1994)
- Assael BM, "Congenital reflux nephropathy : a follow-up of 108 cases diagnosed perinatally", British Journal of Urology, 82, pp.252~257 (1998)
- Olbing H, "New renal scars in children with severe VUR : a 10-year study of randomized treatment", Pediatric Nephrology, 18, pp.1128~1131 (2003)
- Peters CA, "Summary of the AUA Guideline on Management of Primary Vesicoureteral Reflux in Children", The Journal of Urology, 184, pp.1134~1144 (2010)
- Subcommittee on Urinary Tract Infection SCoQI, Management, "Urinary tract infection : clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months", Pediatrics, 128, pp.595~610 (2011)
- Tekgul S, "EAU guidelines on vesicoureteral reflux in children", European Urology, 62, pp.534~542 (2012)
- Williams G, "Antibiotics for the prevention of urinary tract infection in children : A systematic review of randomized controlled trials", The Journal of Pediatrics, 138, pp.868~874 (2001)
- Venhola M, "Meta-analysis of vesicoureteral reflux and urinary tract infection in children", Scandinavian Journal of Urology and Nephrology, 40, pp.98~102 (2006)
- Jodal U, "Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children", Pediatric Nephrology, 21, pp.785~792 (2006)
- Wadie GM, "The impact of vesicoureteral reflux treatment on the incidence of urinary tract infection", Pediatric Nephrology, 27, pp.529~538 (2012)
- Birmingham Reflux Study Group, "Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five years' observation", British Medical Journal, 295, pp.237~241 (1987)
- Nagler EV, "Interventions for primary vesicoureteric reflux", The Cochrane Database of Systematic Reviews, pp.CD001532~ (2011)
- Holmdahl G, "The Swedish reflux trial in children: II. Vesicoureteral reflux outcome", The Journal of Urology, 184, pp.280~285 (2010)
- Cara-Fuentes G, "The RIVUR study : a review of its findings", Pediatric Nephrology, 30, pp.703~706 (2015)
- Investigators RT, "Antimicrobial prophylaxis for children with vesicoureteral reflux", The New England Journal of Medicine, 370, pp.2367~2376 (2014)
- Hari P, "Antibiotic prophylaxis in the management of vesicoureteric reflux : a randomized double-blind placebo-controlled trial", Pediatric Nephrology, 30, pp.479~486 (2015)
- Lee SJ, "Probiotics prophylaxis in children with persistent primary vesicoureteral reflux", Pediatric Nephrology, 22, pp.1315~1320 (2007)
- Lee SJ, "Probiotics prophylaxis in infants with primary vesicoureteral reflux", Pediatric Nephrology, 30, pp.609~613 (2015)