Evaluation of patients wi̇th vesi̇coureteral reflux, in Gaziantep University, cli̇ni̇c of pedi̇atri̇c nephrology

Objective: We aimed to provide useful data about diagnosis, treatment strategies and prognosis of primary vesicoureteral reflux (VUR) by following the patients' clinical and labarotary findings diagnosed as primary VUR in our pediatric nephrology clinic. Materials and Methods: 118 patients with VUR, followed between 2006-2014, were included in our study. We performed a retrospective review of patients' records including their clinical findings at the admission, laboratory results, radiological reports, duration and type of profilaxis they received, frequency of urinary tract infection (UTI) under prophylaxy, new scar appearance rate and it's relation with infection, spontaneous recovering rate, type of surgical interventions and their success rate. The Results: 118 patients with VUR reviewed; 42.4% of them were female, 57.6% were male. The average age was 37.1 ± 43.7 months. The most frequent complaint was fever (38%), while the others were vomiting, abdominal pain, discomfort, dysuria, daytime incontinence and nocturia. 63.7% of patients had recurrent UTI history. Antenatal hydronephrosis was detected in 27.8% of patients. 11 patients had hypertension, 5 of them had chronic kidney disease, 28 of them had growth retardation. 49.4% of the patients had renal scar at dimercaptosuccinic acid (DMSA) renal scan, 53% of them had pathological findings in ultrasonographic evaluation. According to the voiding cystouretrography (VCUG) performed at 176 renal units, 38.1 % of low degree (1-2. Degree) ,31.8% of moderate (3. Degree), 30.1 % of high degree (4-5. Degree) VUR was detected. During their clinical follow up 50.6% recovered spontaneously, 3.8% had partial recovery, 45,5% had no recovery. When compared VUR grade and scar status, patients with high-grade reflux had significantly higher scar rate (p=0.001). When we look at the relation between renal scar and USG findings: patients who have pathologic USG findings had higher scar rates than others (p=0.048). Comparing the grade of reflux and relation with spontaneous recovery; patients with low grade reflux had higher spontaneous recovery rate than others (p=0.001). When we compared voiding dysfunction and urinary tract infection, during the treatment patients without voiding disfunction had experience UTI less frequent than others (p=0.015). Conclusion: Patients with history of recurrent UTI and antenatal hydronephrosis should be investigated in terms of VUR. As low grade VUR usually recovers spontaneously, has low rate of renal scar formation and resistance problem after antibiotic prophylaxy; prophylaxy should be given only in patient-based assesment. Keywords: Urinary tract infection, renal scarring, vesicoureteral reflux