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Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children

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Abstract

For the comparison of long-term outcome of the management of medical or surgical treatment of children with severe vesicoureteral reflux (VUR), children aged <11 years with non-obstructive grade III/IV reflux, previous urinary tract infection (UTI) and glomerular filtration rate (GFR) ≥70 ml/min per 1.73 m2 body surface area were recruited, and 306 were randomly allocated to receive antimicrobial prophylaxis or ureteral reimplantation. Primary endpoints were new renal scars and renal growth. Follow up, originally planned for 5 years, was extended to 10 years for 252 children, 223 of whom had follow-up imaging. Up to 5 years, 40 new urographic scars (medical 19, surgical 21) were seen. Between 5 years and 10 years, only two further scars were observed. Renal growth and UTI recurrence rate were similar, except that medically treated patients had more febrile infections. There was no difference in somatic growth, radionuclide imaging or renal function. A GFR <70 ml/min per 1.73 m2 was found in only one patient. Three patients developed hypertension requiring treatment. We conclude that, with close supervision and prompt treatment of recurrences, children entering the study with GFR ≥70 ml/min per 1.73 m2 progressed remarkably well under either medical or surgical management, emphasizing the importance of continued supervision and the entry level of renal function.

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Acknowledgements

This study was supported by the VW Foundation (grants AZ 35 807 and AZ I/37 504) and by the German Government (Bundesministerium für Forschung und Technologie, grant 07068343; Bundesministerium für Wissenschaft und Forschung, grants 07 06570/0 GFF and 01 EP 95084/4 DLR).

Author information

Authors and Affiliations

  1. The Pediatric Uro-Nephrologic Centre, The Queen Silvia Children’s Hospital, Göteborg University, 416 85, Gothenburg, Sweden

    Ulf Jodal

  2. The Department of Paediatrics, University College London Hospitals, London, UK

    Jean M. Smellie

  3. Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University of Essen, Essen, Germany

    Hildegard Lax

  4. Clinic of Paediatric Nephrology, University Children’s Hospital, Essen, Germany

    Peter F. Hoyer

Authors
  1. Ulf Jodal
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  2. Jean M. Smellie
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  3. Hildegard Lax
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  4. Peter F. Hoyer
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Corresponding author

Correspondence to Ulf Jodal.

Additional information

This paper is presented as a tribute to the late Professors Hermann Olbing and Paul Mellin of Essen, who conceived this study in 1978; to the late Dr. John Duckett of Philadelphia, who, with Professor Adrian Spitzer and Dr. Robert Weiss of New York, promoted and maintained the American limb; to Dr. Tytti Tamminen-Möbius, who coordinated the study, and to Herbert Hirche, statistician. Finally, we wish to acknowledge and thank all the children and their parents who agreed to participate in the study and adhere to the follow-up protocol, 252 of them for 10 years.

The authors are the writing committee of the European arm of the International Reflux Study in Children. Co-ordinating centre, Essen, Germany: chairman H. Olbing (deceased), scientific coordinator T. Tamminen-Möbius, statistics H. Hirche, documentation H. Lax.

Participating university hospitals and investigators were Bonn, Germany: R. Mallmann, D. Emons; Brussels, Belgium: M. Hall, A. Piepsz, C. Schulmann; Essen, Germany: H.J. Bachmann, W. Rascher, E. Brunier, C. Reiners, J. Behrendt, P. Mellin (deceased); Göteborg, Sweden: U. Jodal, K. Hjälmås (deceased), E. Hanson, N. Nilsson, J. Bjure (deceased), R. Sixt; Hamburg, Germany: R. Busch, C. Montz; Helsinki, Finland: O. Koskimies, S. Wikström, E. Marttinen, A. Kivisaari, T. Korppi-Tommola; Oulu, Finland: J. Seppänen (deceased), N.P. Huttunen, U. Seppänen, J. Heikkilä; Stockholm, Sweden: A. Aperia, G. Löhr, P. Herin, U. Freyschuss, L. Blom, U. Erasmi, B. Söderborg. Consultants: I. Claesson, K.-D. Ebel, R.A. Lebowitz, K. Parkkulainen (deceased), J.M. Smellie, I. Wikstad, and J. Winberg (deceased). External Monitoring Committee: C. Meinert (chairman), H.-K. Selbmann, J.M. Smellie, J. Gillenwater, and H.J. Jesdinski (deceased).

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Jodal, U., Smellie, J.M., Lax, H. et al. Ten-year results of randomized treatment of children with severe vesicoureteral reflux. Final report of the International Reflux Study in Children. Pediatr Nephrol 21, 785–792 (2006). https://doi.org/10.1007/s00467-006-0063-0

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