Abstract
The importance of infection and vesico-ureteric reflux in the development of reflux nephropathy is generally accepted. Widespread use of antenatal ultrasound scanning has identified dilated fetal urinary tracts, allowing prompt investigation and treatment in the early post-natal period; some of these children have vesico-ureteric reflux. This study compares renal parenchymal damage, demonstrated by uptake of technetium 99m dimercaptosuccinic acid (DMSA) in two groups. The first included babies less than 6 months old who had presented with their first urinary tract infection and had vesico-ureteric reflux. The second included those in whom a dilated urinary tract had been identified at antenatal ultrasound and post-natal investigation revealed vesico-ureteric reflux, but who had no evidence of urinary tract infection. Renal damage was present in 68% of group 1 and 29% of group 2 when DMSA scanning was used to detect scarring (P = <0.05). Our results support the proposal that infection is a major factor in development of renal damage in patients with vesico-ureteric reflux. Identification by antenatal ultrasound scanning allows early therapeutic intervention before renal damage occurs.
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Brown T, Marchell J, Labowitz RL (1987) Neonatal hydronephrosis in the era of sonography. AJR 148: 956–963
Decter RM, Roth DR, Gonzales ET, (1988) Vesicoureteral reflux in boys. J Urol 140: 1089–1091
Edwards D, Normand ICS, Prescott N, Smellie JM (1977) Disapperance of vesicoureteral reflux during long term prophylaxis of urinary tract infection in children. Br Med J 2: 235–292
Godley ML, Risdon RA, Ransley PG (1989) Effect of unilateral vesicoureteric reflux on renal growth and uptake of 99mTc DMSA by the kidney. An experimental study in the minipig. Br J Urol 63: 340–347
Hodson CJ, Edwards D (1960) Chronic pyelonephritis and vesicoureteric reflux. Clin Radiol 11: 219–231
Hodson CJ, Maling TMJ, McManamon PJ, Lewis MG (1975) The pathogenesis of reflux nephropathy (chronic atrophic pyelonephritis). Br J Radiol [Suppl] 13: 1–26
Mackie GG, Stephens FD, Duplex Kidneys (1975) A correlation of renal dysplasia with position of ureteral orifice. J Urol 114: 274–280
Ransley PG, Risdon RA (1979) The renal papilla, intrarenal reflux and chronic pyelonephritis. In: Hodson CJ, Kincaid-Smith (eds) Reflux nephropathy. New York, Masson
Ransley PG, Risdon RA (1978) Reflux and renal scarring. Br J Radiol [Suppl] 14: 1–35.
Rolleston GL, Shannon FT, Utley WLF (1970) Relationship of infantile vesico ureteric reflux to renal damage. Br Med J 1: 460–463
Sampson JA, (1903) Ascending renal infection with special reference to the reflux of urine from the bladder into the ureters as an aetiological factor in its causation and maintenance. Bulletin of the John Hopkins Hospital; 14: 334–350
Scott JES (1987) Fetal ureteric reflux. Br J Urol 59: 291–296
Scott JES Renwick M (1988) Antenatal diagnosis of congenital abnormalities in the urinary tract. Br J Urol 62: 295–300
Smellie JM, Hodson CJ, Edwards D, Normand ICS (1964) Clinical and radiological features of urinary tract infection in childhood. Br Med J 2: 1222–1226
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Sheridan, M., Jewkes, F. & Gough, D.C.S. Reflux nephropathy in the 1st year of life — the role of infection. Pediatr Surg Int 6, 214–216 (1991). https://doi.org/10.1007/BF00176072
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DOI: https://doi.org/10.1007/BF00176072