Bilateral Scars May Worsen Outcomes

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Moderate or severe renal dysfunction found only in patients with VUR scarring in both kidneys.

 

Children treated for vesicoureteral reflux (VUR) may be at higher risk of diminished kidney function in middle age if they suffered bilateral renal scarring, investigators report.

 

A team led by Tuija Lahdes-Vasama, MD, of Tampere University Hospital in Helsinki, studied 127 adults (113 women, 14 men) who as children were treated for VUR of any grade. VUR was diagnosed at a mean age of 4.3 years. The patients (average age 41 years) had an aver-age follow-up time of 37 years.

 

Ultrasound examination revealed no signs of renal scarring in 53 patients (42%), unilateral scarring in 44 (35%), and bilateral scarring in 30 (24%), according to a report in Nephrology Dialysis Transplantation (2006;21:2491-2497). Four of the 127 patients had moderate or severe renal insufficiency, defined as a glomerular filtration rate (GFR) of 30-59 and 15-29 mL/min/1.73 m2, respectively. All of these patients had bilateral scarring. Abnormal renal function (GFR below 90 mL/min/1.73 m2) was observed in 60 patients with no scars or unilateral scars (62%) versus 25 patients with bilateral scars (83%). Hypertension was diagnosed in 14 patients, eight of whom had bilateral scars.

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