Spontaneous Resolution Rate and Predictive Factors of Resolution in Children with Primary Vesicoureteral Reflux

Kang, Eun-Young; Kim, Min-Sun; Kwon, Keun-Sang; Park, Eun-Hye; Lee, Dae-Yeol

doi:2007.11.1.74

J Korean Soc Pediatr Nephrol > Volume 11(1); 2007 > Article

J Korean Soc Pediatr Nephrol 2007;11(1): 74-82. doi: https://doi.org/10.3339/jkspn.2007.11.1.74

소아에서 일차성 방광요관역류의 자연소실율 및 관련 인자

강은영, 김민선, 권근상, 박은혜, 이대열

¹전북대학교 의과대학 소아과학교실, 임상의학연구소
²전북대학교 의과대학 소아과학교실, 임상의학연구소
³전북대학교 의과대학 예방의학교실
⁴전북대학교 의과대학 소아과학교실, 임상의학연구소
⁵전북대학교 의과대학 소아과학교실, 임상의학연구소

Spontaneous Resolution Rate and Predictive Factors of Resolution in Children with Primary Vesicoureteral Reflux

Eun-Young Kang, Min-Sun Kim, Keun-Sang Kwon, Eun-Hye Park, Dae-Yeol Lee

¹Department of Pediatrics, Research Institute of Clinical Medicine, Chonbuk National University Medical School
²Department of Pediatrics, Research Institute of Clinical Medicine, Chonbuk National University Medical School
³Department of Preventive Medicine and Public Health, Chonbuk National University Medical School
⁴Department of Pediatrics, Research Institute of Clinical Medicine, Chonbuk National University Medical School
⁵Department of Pediatrics, Research Institute of Clinical Medicine, Chonbuk National University Medical School

ABSTRACT

Purpose : To analyze the clinical characteristics, spontaneous resolution rate and predictive factors of resolution in children with primary vesicoureteral reflux(VUR).
Methods : Between October 1991 and July 2003, 149 children diagnosed with primary VUR at Chonbuk National University Hospital were reviewed retrospectively. All of the patients were maintained on low-dose antibiotic prophylaxis and underwent radionuclide cystograms at 1 year intervals over 3 years after the initial diagnosis of VUR by voiding cystourethrogram was made.
Results : The median time to resolution of VUR was 24 months and the total 3 year-cumulative resolution rate of VUR was 61.7%. The following variables were associated with resolution of VUR according to univariate analysis-; age<1 year, male gender, mild grade of reflux, unilateral reflux, congenital hydronephrosis as clinical presentation at time of diagnosis of VUR, absence of focal defects in the renal scan at diagnosis, absence of recurrent UTI, renal scars and small kidney during follow-up. After adjustment by Cox regression model, five variables remained as independent predictors of VUR resolution; age<1 yew, relative risk 1.77(P<0.05), VUR grade I+II 2.98(P<0.05), absence of renal scars 2.23(P<0.05), and absence of small kidney 5.20(P<0.01) during follow-up.
Conclusion : In this study, spontaneous resolution rate of VUR, even high grade reflux, is high in infants during medical management, and it was related to age, reflux grade at diagnosis, absence of renal scars and small kidney during follow-up. Therefore early surgical intervention should be avoided and reserved for the selected groups.

Key words: Vesicoureteral reflux | Urinary tract infection | Renal scar | Resolution