Effects of Intrarenal Reflux on Renal Growth in Children With Grades III-V Primary Vesicoureteral Reflux

Abstract

The phenomenon of intrarenal reflux (IRR) has been considered a crucial link between vesicoureteral reflux (VUR) and segmental scarring. We conducted a study on renal length in 104 children diagnosed with Grades III-V VUR, with or without IRR, using contrast-enhanced voiding urosonography (ceVUS). The patients were divided into two treatment groups: the conservative antibiotic prophylaxis (CAP) group and the operation group, which were further categorized into two subgroups: the IRR group and the non-IRR group. Our findings revealed an incidence rate of 35.96% (41/114) for IRR occurrence, with 43.42% (33/76) occurring in upper renal segments, 32.89% (25/76) in lower segments, and 23.68% (18/76) in middle segments. In the CAP group where the effects of IRR persisted, the renal growth observed was as follows: IRR group-0.19 ± 0.13 cm; non-IRR group-0.39 ± 0.23 cm; contralateral negative group-0.66 ± 0.35 cm; control group-0.46 ± 0 .25 cm respectively (P < .05). In the operation group, where the effects of IRR were eliminated, the renal growth for the IRR group, non-IRR group, contralateral negative group, and control group was 0.46 ± 0.22 cm, 0.54 ± 0.31 cm, 0.67 ± 0 .42 cm, and 0.36 ± 0.17 cm respectively (P < .005). In conclusion, the presence of IRR can impact renal growth in children diagnosed with Grades III-V primary VUR. Following surgical intervention, the IRR kidney does not exhibit catch-up growth; however, it demonstrates parallel growth alongside the unaffected kidney. Conversely, the non-IRR kidney experiences catch-up growth. Therefore, for children presenting with Grades III-V primary VUR combined with IRR, a more aggressive treatment approach such as surgery is recommended.

Keywords: contrast‐enhanced voiding urosonography (ceVUS); intrarenal reflux (IRR); primary vesicoureteral reflux (VUR); renal growth.