J Korean Soc Pediatr Nephrol > Volume 10(2); 2006 > Article
J Korean Soc Pediatr Nephrol 2006;10(2): 201-212.
방광요관역류와 신반흔
남희영, 신준헌, 이준호, 최은나, 박혜원
1포천중문의과대학교 소아과학교실
2포천중문의과대학교 소아과학교실
3포천중문의과대학교 소아과학교실
4포천중문의과대학교 소아과학교실
5포천중문의과대학교 소아과학교실
Vesicoureteral Reflux and Renal Scar
Hee-Young Nam, Joon-Heon Shin, Jun-Ho Lee, Eun-Na Choi, Hye-Won Park
1Department of Pediatrics, College of Medicine, Pochon CHA University
2Department of Pediatrics, College of Medicine, Pochon CHA University
3Department of Pediatrics, College of Medicine, Pochon CHA University
4Department of Pediatrics, College of Medicine, Pochon CHA University
5Department of Pediatrics, College of Medicine, Pochon CHA University
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Purpose : Vesicoureteral reflux(VUR) is the major risk factor of urinary tract infection(UTI) in children and may result in serious complications such as renal scarring and chronic renal failure. The purpose of this study was to evaluate the relationship between VUR and renal scar formation, the usefulness and correlation of various imaging studies in reflux nephropathy, and the spontaneous resolution of VUR.
Methods : We retrospectively reviewed 106 patients with VUR with no accompanying urogenital anomalies in the Department of Pediatrics, Bundang CHA Hospital during the period from Jan. 1996 to Mar. 2005. Ultrasonography and $^{99m}Tc$-dimercaptosuccinic acid(DMSA) scan were performed in the acute period of UTI. Voiding cystourethrography(VCUG) was performed 1 to 3 weeks after treatment with UTI. Follow-up DMSA scan was performed 4 to 6 months after treatment and a follow-up VCUG was performed every 12 months.
Results : The mean age at detection of VUR was $13.8{pm}22.2$ months and the male to female ratio was 2:1. The incidence of renal scarring showed a tendency of direct correlation between severity of VUR(P<0.001) and abnormal findings of renal ultrasonography(P<0.01). 63.2%(24 of 38 renal units) of renal parenchymal defects present in the first DMSA scan disappeared on follow-up DMSA scans. Follow-up DMSA scans detected renal scars in 7(14%) of 50 renal units with ultrasonographically normal kidneys. Meanwhile, ultrasonography did not show parenchymal defects in 7(36.8%) of 19 renal units where renal scarring was demonstrated on a follow-up DMSA scan. The spontaneous resolution rate of VUR was higher(75%) in cases with low grade(I to III) VUR(P<0.01).
Conclusions : The presence and severity of VUR and abnormal findings of renal ultrasonography significantly correlated with renal scar formation. DMSA scan was useful in the diagnosis of renal defects. Meanwhile renal ultrasonography was an inadequate method for evaluating renal parenchymal damage. Therefore, follow-up DMSA scans should be performed to detect renal scars even in children with low-grade VUR and normal renal ultrasonography.
Key words: Vesicoureteral reflux | Renal scar | Renal ultrasonography | $^{99m}Tc$ dimercaptosuccinic acid(DMSA) scan | Resolution
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