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Njurskada hos barn randomiserade till profylax, endoskopisk injektion eller observation. Resultat från Svenska Refluxstudien

Poster
Authors Per Brandström
Ulf Jodal
Rune Sixt
Eira Stokland
Sverker Hansson
Published in Konferensprogram, 43rd Annual Scientific Meeting of the European Society for Paediatric Nephrology. 2-5 september 2009, Birmingham, England.
Publication year 2009
Published at Institute of Clinical Sciences
Language en
Keywords Vesikoureteral reflux, njurskada, barn, 99mTc-DMSA
Subject categories Pediatrics, Pediatric surgery, Clinical physiology

Abstract

Objectives and Study: To compare the risk of renal damage in children with dilated vesicoureteral reflux (VUR) grade III-IV randomized to antibiotic prophylaxis, endoscopic injection or surveillance. Methods: Children 1-2 years of age with VUR III-IV were randomized to one of the three treatment arms. Voiding cystourethrography (VCUG) and DMSA scintigraphy were performed at entry and after 2 years. End points were febrile urinary tract infections (UTI), development of renal damage and VUR. Abnormality on DMSA was defined as a focal defect with split function of 45% or more (class 1), split funtion 40-44% irrespective of focal defects (class 2), or split funtion <40% (class 3). Progress of damage was defined as a decrease in split function of 3% or more, and new damage reduced uptake in a previously normal area of the kidney. Results: The included 203 children were allocated to prophylaxis (n=69), endoscopic treatment (n=66), and surveillance (n=68). At entry 123 patients had an abnormal DMSA; 18 of these were bilateral. At the 2 year DMSA, 23 showed progress of damage with no difference between treatment arms. Progress of renal damage was seen in 12 of 49 (24%) children with febrile recurrences as compared to 11 of 154 (7%) in those without febrile recurrences (p<0.001). New renal damage was seen in 10 of 49 (20%) children with febrile recurrences as compared to 4 of 154(2.5%) of those without febrile recurrences (p<0.0001). Conclusions: New damage occurred significantly more often in the surveillance and endoscopic groups than in the prophylaxis group. There was no difference in progress of renal damage between the three treatment arms. The risk of progress of renal damage as well as development of new renal damage was significantly correlated to the rate of recurrent febrile UTIs. In this study of small children with VUR grade III-IV antibacterial prophylaxis reduced the risk of new renal damage and recurrent UTI.

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