Evaluation of patients aged 0-18 years WHO were followed up for vesicoureteral reflux in Ondokuz Mayis University, department of pediatric nephrology between 2010-2021

Objective: Vesicourethral reflux (VUR) is the escape of urine from the bladder back to the upper urinary tract. According to the underlying cause, it is divided into two groups as primary and secondary. The clinical significance of VUR is based on the assumption that infected urine in patients with VUR carries bacteria from the bladder to the kidney, predisposing patients to acute pyelonephritis, which can lead to kidney scarring, hypertension, and chronic kidney disease. However, the factors affecting kidney scarring in patients with VUR are increasingly questioned. In conclusion, the clinical effect and treatment of VUR is controversial. Our aim in this study is to reveal the clinical, laboratory, imaging findings, follow-up and treatment results of patients who were followed up with the diagnosis of primary VUR in the Department of Pediatric Nephrology of Ondokuz Mayıs University between 01.01.2010 and 31.12.2021 and to determine the factors affecting the prognosis Material and method: In the study, the files of 263 patients who were followed up with the diagnosis of VUR between 01.01.2010 and 31.12.2021 were retrospectively examined. The study included patients with primary VUR who were admitted to a pediatric nephrology clinic between the ages of 0-18 years, who underwent urinary system ultrasonography, voiding cystourethrography (VCUG) and renal cortical kidney scintigraphy (Tc-99m DMSA), and who had VUR detected in VCUG Results: Of the 263 patients examined in the study, 40.7% were male and 59.3% were female. The mean age of admission was 3.80 ± 3.80 years (median 3.08 years), and the mean follow-up period was 3.99 ± 3.23 years (median 3.12 years). In our patient group, those with a diagnosis of high-grade reflux (150 patients, 57.03%) were predominant. While low-to-moderate reflux was detected more in female patients (86 patients, 55.1%), higher grade reflux was detected in male patients (80 patients, 74.8%). The most common reason for admission to our clinic was urinary tract infection with 79.1% and antenatal hydronephrosis (HN) with 17.5% of the patients. While HN was detected in 34.5% of patients with low moderate reflux, HN was detected in 57.3% of patients with high-grade reflux. HN was significantly higher in patients with high-grade reflux (p<0.05). Glomerular filtration rate (GFR) was used to evaluate renal function. In male patients and patients with renal scarring, GFR was lower (p<0.05). When patients with renal scarring and patients without it were compared, there was no statistically significant difference in terms of gender and reflux degree. However, renal scarring was higher in patients who did not use prophylactic antibiotics (p<0.05). In short, in our study, there was no difference between increased reflux degree and decrease in GFR and renal scarring. Recurrent urinary tract infection (UTI) was significantly higher in girls than in boys as expected (p<0.05). Some patients with renal scarring had proteinuria and hypertension, but there was no statistically significant difference compared to patients without scarring. In terms of treatment, while 42.6% of the patients were followed conservatively, endoscopic and/or open surgery was performed in 57.4% of the patients, and female patients were operated more frequently than male patients (p=0,032). At the same time, it was observed that the patients with recurrent infections and with renal scars were operated at a higher rate (p<0,05 and p<0.05). Discussion and conclusion: Primary VUR causes recurrent urinary tract infections, renal parenchymal scar, hypertension, proteinuria and chronic kidney disease with decreased glomerular filtration rate. According to our study, GFR is significantly lower in children with renal scarring. Contrary to the literature, there is no relationship between increased reflux degree and decrease in GFR and renal scarring. In recent years, the use of prophylactic antibiotics, which is a very controversial issue, has also been examined and it has been shown to reduce renal scarring in our study. Considering that our study group consisted mostly of high-grade reflux patients, the use of prophylactic antibiotics may be beneficial for kidney function in the long term, especially in high-grade reflux patients. In addition, HN was not detected in ultrasonography in approximately half of the patients in our study, teherefore it should be kept in mind that renal ultrasonography may be normal in patients with VUR. Keywords: vesicoureteral reflux; renal scar, urinary tract infection