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Clinical course of 735 children and adolescents with primary vesicoureteral reflux

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Abstract

The purpose of this retrospective cohort study was to report the clinical course of children with primary vesicoureteral reflux (VUR). Between 1970 and 2004, 735 patients were diagnosed with VUR and were systematically followed in a single tertiary renal unit. Patients were followed up for a mean time of 76 months (6 months to 411 months). The events of interest were reflux resolution, renal damage, urinary tract infection (UTI), chronic kidney disease (CKD), and hypertension. Survival analysis was performed in order to evaluate reflux resolution and CKD. Renal damage was detected at admission in 319 patients (43.4%). Continuous low-dose antibiotic prophylaxis was administered to 624 patients (91.2%); 499 (73%) patients subsequently had no UTI or fewer than three episodes. The median time of persistence of reflux according to Kaplan–Meier analysis was 38 months for grade I/II [95% confidence interval (95% CI), 33–43], 98 months for grade III (95% CI, 78.5–105), and 156 months for grade IV/V (95% CI, 122–189). Twenty patients (3%) developed hypertension. It was estimated that the probability of CKD was 5% at 10 years after diagnosis of VUR; for children diagnosed after 1990 the probability of CKD was only 2%. Renal function impairment occurred in patients with severe bilateral reflux or in patients with contralateral renal hypoplasia. There has been an improvement of prognosis for patients diagnosed in the past 15 years.

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Acknowledgments

This study was partially supported by CNPq (Brazilian National Research Council) and Pró-Reitoria de Pesquisa (UFMG). M.A.V. was a recipient of the CNPq fellowship.

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Authors and Affiliations

  1. Pediatric Nephrourology Unit, Department of Pediatrics, Hospital Das Clinicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Jose Maria Penido Silva, Jose Silverio Santos Diniz, Viviane Santuari Parizzoto Marino, Eleonora Moreira Lima, Luis Sergio Bahia Cardoso & Eduardo Araujo Oliveira

  2. CNPq fellowship, Department of Pediatrics, Hospital Das Clinicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

    Mariana Affonso Vasconcelos

  3. Rua Engenheiro Amaro Lanari 389 / 501, Belo Horizonte, Minas Gerais, 30.310.580, Brazil

    Eduardo Araujo Oliveira

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  1. Jose Maria Penido Silva
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  2. Jose Silverio Santos Diniz
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  3. Viviane Santuari Parizzoto Marino
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  4. Eleonora Moreira Lima
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  5. Luis Sergio Bahia Cardoso
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  6. Mariana Affonso Vasconcelos
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  7. Eduardo Araujo Oliveira
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Correspondence to Eduardo Araujo Oliveira.

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Silva, J.M.P., Santos Diniz, J.S., Marino, V.S.P. et al. Clinical course of 735 children and adolescents with primary vesicoureteral reflux. Pediatr Nephrol 21, 981–988 (2006). https://doi.org/10.1007/s00467-006-0151-1

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  • DOI: https://doi.org/10.1007/s00467-006-0151-1

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