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Renal damage in children randomized to prophylaxis, endoscopic injection, or surveillance

Authors Per Brandström
T. Neveus
Rune Sixt
Eira Stokland
Ulf Jodal
Sverker Hansson
Published in European Society for Paediatric Urology Annual Meeting, 28 april-1 maj 2010, Antalya, Turkiet,
Publication year 2010
Published at Institute of Clinical Sciences, Department of Pediatrics
Language en
Keywords Vesikoureteral reflux, njurskada, urinvägsinfektion,
Subject categories Pediatric surgery, Pediatrics


PURPOSE To compare the development of new renal damage in small children with dilating vesicoureteral reflux randomly allocated to antibiotic prophylaxis, endoscopic treatment or surveillance (control group). MATERIAL AND METHODS Included were 203 children, 128 girls and 75 boys, aged 1 to less than 2 years with reflux grade III to IV. Voiding cystourethrography and 99mTcdimercaptosuccinic acid scintigraphy were performed before randomization and after 2 years. Febrile urinary tract infections were recorded during the follow-up. Data analysis was performed according to the intention-to-treat principle. RESULTS New renal damage in a previously unscarred area was seen in 15 children, 13 girls and 2 boys. Eight of these 13 girls were in the surveillance, 5 in the endoscopic, and none in the prophylaxis group (p=0.0155). New damage was seen more often in children with (11/49, 22%) than without (4/152, 3%) febrile recurrence (p<0.0001). CONCLUSIONS In boys the rate of new renal damage was low. It was significantly higher in girls, being most frequent in the surveillance (control) group. There was also a strong association between febrile UTI recurrence and development of new renal damage in girls.

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