Primary Vesicoureteral Reflux in Children in Southern Iran

Background: Experience with vesicoureteral reflux (VUR) differs in different centers and there is plenty of controversies.Objective: To evaluate the outcome of primary VUR complications and the rate of recurrence of UTI.Methods:  In a retrospective study, the medical charts of all infants and children with primary VUR who were followed up by one nephrologist were reviewed.  During 16 years, 271 patients (226 females, 45 males) with 401 refluxing ureters were followed up as primary VUR.Results: The patients’ age at diagnosis was 4 days to 16 years (Mean: 4.4 years) and the mean duration of follow-up was 4.2 years.  Urinary tract infection (UTI) was the presenting symptom in 97% and fever was recorded in 30% of cases.  Frequencies of different grades of VUR at initial investigation were 6.5%, 52%, 23.4% and 18.1% for grades I to IV, respectively.  The responsible microorganism in 90% of the first episodes of UTI was E. coli.  Scarring or small size kidney was present in 63 patients.  Recurrence of UTI in VUR of grades I to IV, were 68.7%, 51%, 60.1% and 46.8%, respectively.  Follow-up voiding cystourethrogram revealed resolution of VUR in 52%, improvement in 31%, no change in 11%, and deterioration in 6%.  Complications such as chronic renal failure, hypertension and renal tubular acidosis were observed in 11, 10 and 9 patients, respectively.Conclusion: Symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not related to the grade of VUR.