Objective:To assess the clinical outcome and imaging features of neonatal pri mary vesicoureteral reflux(VUR).Study design:We prospectively followed 43 inf ants with primary VUR identified from among a cohort of 497 i...Objective:To assess the clinical outcome and imaging features of neonatal pri mary vesicoureteral reflux(VUR).Study design:We prospectively followed 43 inf ants with primary VUR identified from among a cohort of 497 infants with fetal r enal pelvis dilatation.Postnatal renal ultrasound(US)examinations were perfor med at 5 days and 1,3,6,12,and 24 months of life.Voiding cystourethrography was performed in the neonatal period and repeated at 12 and 24 months when VUR was persistent.Two radioisotopic examinations,including a 99mTc-MAG3 renogram and a plasma clearance of Cr-51 EDTA,were performed in all children with high-grade reflux.Results:The incidence of primary VUR in our study group was 9%.Among the 43 patients followed,11(26%)had high-grade(IV-V)VUR and 32(74%)had low-grade VUR.Resolution of reflux occurred in 2 of 11(18%)patien ts with high-grade VUR and in 29 of 32(90.6%)patients with low-grade VUR at age 2 years(P < 0.001).At age 2 years,91%of the low-grade refluxing kidne ys were normal on US,compared with only 35%of the high-grade refluxing kidney s.Split renal function was within normal range and single-kidney GFR was signi ficantly increased in 13 of the 17 high-grade refluxing kidneys during follow-up.Furthermore,a strong association between dysplasia on US and poor renal fun ction outcome was found.Conclusions:In most infants with VUR,the reflux is of low grade and resolves rapidly.In those children with high-grade VUR,spontan eous resolution is rare at age 2 years,but persistent reflux rarely impairs the maturation of renal function.展开更多
文摘Objective:To assess the clinical outcome and imaging features of neonatal pri mary vesicoureteral reflux(VUR).Study design:We prospectively followed 43 inf ants with primary VUR identified from among a cohort of 497 infants with fetal r enal pelvis dilatation.Postnatal renal ultrasound(US)examinations were perfor med at 5 days and 1,3,6,12,and 24 months of life.Voiding cystourethrography was performed in the neonatal period and repeated at 12 and 24 months when VUR was persistent.Two radioisotopic examinations,including a 99mTc-MAG3 renogram and a plasma clearance of Cr-51 EDTA,were performed in all children with high-grade reflux.Results:The incidence of primary VUR in our study group was 9%.Among the 43 patients followed,11(26%)had high-grade(IV-V)VUR and 32(74%)had low-grade VUR.Resolution of reflux occurred in 2 of 11(18%)patien ts with high-grade VUR and in 29 of 32(90.6%)patients with low-grade VUR at age 2 years(P < 0.001).At age 2 years,91%of the low-grade refluxing kidne ys were normal on US,compared with only 35%of the high-grade refluxing kidney s.Split renal function was within normal range and single-kidney GFR was signi ficantly increased in 13 of the 17 high-grade refluxing kidneys during follow-up.Furthermore,a strong association between dysplasia on US and poor renal fun ction outcome was found.Conclusions:In most infants with VUR,the reflux is of low grade and resolves rapidly.In those children with high-grade VUR,spontan eous resolution is rare at age 2 years,but persistent reflux rarely impairs the maturation of renal function.
