Child Kidney Dis.  2016 Apr;20(1):18-22. 10.3339/jkspn.2016.20.1.18.

High Spontaneous Resolution Rates of Severe Primary Vesicoureteral Reflux and Minimal Development of New Renal Scars

• Cha J
• Lee SJ

• KMID: 2163319
• DOI: http://doi.org/10.3339/jkspn.2016.20.1.18

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. Radioisotope cystourethrography was performed every 1 to 3 years until SR of reflux. New renal scar was evaluated with follow-up 99mTc 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 reported and most new renal scars were focal and mild.

Keyword

Annual spontaneous resolution rate; Median time to SR; Medical prophylaxis

MeSH Terms

Antibiotic Prophylaxis
Cicatrix*
Follow-Up Studies
Humans
Incidence
Medical Records
Probiotics
Retrospective Studies
Technetium Tc 99m Dimercaptosuccinic Acid
Vesico-Ureteral Reflux*
Technetium Tc 99m Dimercaptosuccinic Acid