Outcome of kidneys in patients treated for vesicoureteral reflux (VUR) during childhood.

BACKGROUND Outcome of renal function and blood pressure (BP) at early middle age was clarified in patients treated for vesicoureteral reflux (VUR) during childhood. METHODS Information of renal function was available from 147 (55%) of 267 patients treated for non-obstructive VUR of any grade. Twelve patients had died of kidney-related conditions and eight had gone into terminal uraemia. A total of 127 patients participated in the study. RESULTS The mean age of the participants was 41 years. No signs of renal scars were detected by ultrasound examination in 53 (42%) subjects. Unilateral scarring was seen in 44 (35%) and bilateral in 30 (24%) subjects. Glomerular filtration rate (GFR) showed moderate or severe renal insufficiency in four (3%) participants, all with bilateral scars. Normal GFR was found in one-third of the patients. Twenty-five (83%) subjects with bilateral scars and 60 (62%) of the other participants had abnormal GFR values (P < 0.05). Proteinuria was found in 12 (9%) and albuminuria in 30 (24%) participants. Hypertension was diagnosed earlier in 14 (11%) patients, eight having bilateral scarring (P < 0.01). Diastolic BP was significantly lower in subjects without scars compared with those having scars in one or both kidneys (P < 0.05). CONCLUSIONS Renal function was slightly lowered in more than half of the participants. Findings of the participants with unilateral scarring or unscarred kidneys were similar, except for the increased tendency for hypertension in subjects with scars. A total of 83% of the patients with bilateral kidney scars had lowered kidney function, a quarter presented with proteinuria and a half with hypertension. Long-term follow-up for all the patients with earlier VUR is emphasized.