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The Swedish Reflux Trial in Children: IV. Renal Damage.

Journal article
Authors Per Brandström
Tryggve Nevéus
Rune Sixt
Eira Stokland
Ulf Jodal
Sverker Hansson
Published in The Journal of urology
Volume 184
Issue 1
Pages 292-297
ISSN 1527-3792
Publication year 2010
Published at Institute of Clinical Sciences, Department of Pediatrics
Pages 292-297
Language en
Keywords kidney; urinary tract infections; vesico-ureteral reflux; cicatrix; fever
Subject categories Pediatric surgery, Kidney diseases, Urology and andrology, Pediatrics


PURPOSE: We compared the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance as the control group. MATERIALS AND METHODS: Included in the study were 128 girls and 75 boys 1 to younger than 2 years with grade III-IV reflux. Voiding cystourethrography and dimercapto-succinic acid scintigraphy were done before randomization and after 2 years. Febrile urinary tract infections were recorded during followup. Data analysis was done by the intent to treat principle. RESULTS: New renal damage in a previously unscarred area was seen in 13 girls and 2 boys. Eight of the 13 girls were on surveillance, 5 received endoscopic therapy and none were on prophylaxis (p = 0.0155). New damage was more common in children with than without febrile recurrence (11 of 49 or 22% vs 4 of 152 or 3%, p <0.0001). CONCLUSIONS: In boys the rate of new renal damage was low. It was significantly higher in girls and most common in the control surveillance group. There was also a strong association between recurrent febrile UTIs and new renal damage in girls.

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