CLINICAL PROFILE AND FACTORS AFFECTING SPONTANEOUS RESOLUTION IN CHILDREN WITH PRIMARY VESICOURETERAL REFLUX

Аннотация

Background: The management of primary vesIcoureteral reflux in children has undergone serial changes over the last decade. There has been a trend towards a more conservative management which includes observation, continuous antibiotic prophylaxis, and delayed surgical intervention. Therefore increased knowledge of the natural course of pediatric vesicoureteral reflux and factors affecting the outcome is needed to meet the new trends for management. After excluding a secondary cause of VUR the physician should consider the risk factors affecting the severity of vesicoureteral reflux and manage the child accordingly. These factors include demographic factors (age, gender) and clinical factors (grade, unilateral vs bilateral) presence of renal scars, initial presentation, the number of UTIs and presence of any bowel dysfunction.

Aims and Objectives: 1) To evaluate the clinical course and significant factors in children with primary VUR, and 2) To define more completely the factors that influence the resolution of VUR

Methods: 70 children between ages 0 to 5 years with primary VUR were prospectively studied from September 2017 to September 2019.10 patients were lost to follow up and were excluded from the study. Patients with secondary VUR, solitary kidney, multicystic kidney disease, ectopic ureter, ureterocele, and those with history of anticholinergic use were excluded from the study.

Results: Mean age of patients was 2.083±1.29 years. Most of the patients in the lesser age group showed spontaneous resolution (87%) .30% of the patients were females of which 78% resolved spontaenously. Unilateral reflux was seen in 34% of patients with 76% spontaneous resolution and bilateral reflux was seen in 66% of patients with 41% rate of spontaneous resolution.33% of patients had grade 1 reflux of which 90% resolved spontaneously.23% of patients had grade III – V reflux of which only 39% resolved spontaneously.21% of patients developed breakthrough UTI of which only 7 % showed spontaneous resolution.15% of patients had bladder bowel dysfunction of which 33% showed spontaneous resolution.

Conclusion: The spontaneous resolution of VUR is dependent on age at presentation, sex, grade of reflux, laterality, mode of clinical presentation. Faster resolution of VUR is more likely in children < 1 year at presentation, lower grade of reflux (I-III) and asymptomatic presentation with prenatal hydronephrosis. The presence of renal cortical abnormality, bladder bowel dysfunction and breakthrough febrile UTI are negative predictors of reflux resolution.