Long-term outcome of vesicoureteral reflux associated chronic renal failure in children. Data from the ItalKid Project.

Gianluigi Ardissino, Luigi Avolio, Valeria Dacco, Sara Testa, Giuseppina Marra, Sara Viganò, Silvana Loi, Paolo Caione, Roberto De Castro, Salvatore De Pascale, Efisia Marras, Giovanna Riccipetitoni, Giorgio Selvaggio, Paola Pedotti, Aldo Claris-Appiani, Antonio Ciofani, Luca Dello Strologo, Giuliana Lama, Giovanni Montini, Enrico Verrina

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Abstract

PURPOSE: The nephropathy associated with vesicoureteral reflux (VUR) is one of the leading causes of chronic renal failure (CRF) in children. We describe the clinical course of the disease based on information available in the ItalKid Project database, and analyze the predictive value of baseline renal function, age at VUR diagnosis and urinary protein excretion in relation to the risk of progressive renal failure. MATERIALS AND METHODS: As of December 31, 2001 the registry included a total of 343 patients (261 males) with a diagnosis of primary VUR, which was the leading single cause of CRF, accounting for 25.4% of all patients with CRF. RESULTS: The estimated risk of end stage renal disease (ESRD) by age 20 years was 56%. The patients with a creatinine clearance (Ccr) of less than 40 ml per minute at baseline had an estimated 4-fold greater risk of ESRD developing in comparison with those whose Ccr was 40 to 75 ml per minute. No significant difference in probability of disease progression to ESRD was found between subjects diagnosed with VUR at age 6 months or less and those diagnosed later (older than 6 months). Furthermore, children with normal urinary protein excretion (a urinary protein [uPr]/urinary creatinine [uCr] ratio of less than 0.2 in 36 patients) and low grade proteinuria (uPr/uCr 0.2 to 0.8 in 34 patients) at baseline showed a significantly slower decrease in mean Ccr than those with moderate proteinuria (uPr/uCr greater than 0.8 in 34 patients). Hypertension and/or antihypertensive treatment (including antiprogressive drugs) were reported in 29.1% of patients. CONCLUSIONS: The results of the present study define the long-term risk of ESRD in a large population of children with CRF and VUR, and provide some critical information for identifying the prognosis.

Original languageEnglish
Pages (from-to)305-310
Number of pages6
JournalJournal of Urology
Volume172
Issue number1
Publication statusPublished - Jul 2004

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ASJC Scopus subject areas

  • Urology

Cite this

Ardissino, G., Avolio, L., Dacco, V., Testa, S., Marra, G., Viganò, S., Loi, S., Caione, P., De Castro, R., De Pascale, S., Marras, E., Riccipetitoni, G., Selvaggio, G., Pedotti, P., Claris-Appiani, A., Ciofani, A., Dello Strologo, L., Lama, G., Montini, G., & Verrina, E. (2004). Long-term outcome of vesicoureteral reflux associated chronic renal failure in children. Data from the ItalKid Project. Journal of Urology, 172(1), 305-310.