Evolution and prognosis value of intrarenal reflux

Abstract 

Purpose

The aim of this study was to evaluate the prognostic significance of intrarenal reflux (IRR) regarding urinary tract infection (UTI), renal scarring and spontaneous resolution after 3 years of follow up.

Patients and methods

33 patients (42 refluxing units) with IRR were compared to 27 children (44 refluxing units) with high-grade vesicoureteral reflux (VUR) without IRR (controls) matched for gender, age and VUR grade. All patients received antibiotic prophylaxis during observation and antireflux surgery was performed in children with recurrent UTI. DMSA scan was performed at study entry, and 18 and 36 months.

Results

DMSA scores at entry showed a higher proportion of moderate and severe damage in the IRR group (25/42) compared to the control group (16/44) (Chi squared, P < 0.03). During follow up the incidence of UTI was similar in the two groups, as well as the stability of DMSA scintigraphy and the rate of spontaneous disappearance of the reflux. A similar proportion of patients underwent surgery (18/33 patients with IRR and 13/27 control patients; Chi squared, not significant).

Conclusions

Under medical management, the prognosis for IRR is not different from high-grade VUR without IRR. The presence of IRR does not justify more aggressive management than a high-grade VUR without IRR.

Keywords: Intrarenal reflux, Pyelotubular reflux, Vesicoureteral reflux, Urinary tract infection, DMSA scan

Abbreviations: IRR, intrarenal reflux, VUR, vesicoureteral reflux, UTI, urinary tract infection, 99 m-Tc DMSA scan, technetium dimercaptosuccinic acid scan, CI, confidence interval