PMID- 31570232
OWN - NLM
STAT- MEDLINE
DCOM- 20201103
LR  - 20201103
IS  - 1873-4898 (Electronic)
IS  - 1477-5131 (Linking)
VI  - 15
IP  - 6
DP  - 2019 Dec
TI  - The long-term prognosis of nephropathy in operated reflux.
PG  - 605.e1-605.e8
LID - S1477-5131(19)30252-9 [pii]
LID - 10.1016/j.jpurol.2019.08.015 [doi]
AB  - OBJECTIVE: To investigate the postoperative long-term prognosis and the factors 
      predicting the renal function of patients with reflux nephropathy. As the serum 
      creatinine (s-Cr) level tends to increase during infancy, the degree of reflux 
      and renal parenchymal damage are thought to be more important factors in 
      pediatric patients than in older patients. MATERIALS AND METHODS: This study 
      examined s-Cr, urinary protein, and blood pressure of patients who underwent 
      anti-reflux surgery 10 years before. It also calculated the postoperative 
      estimated glomerular filtration rate (eGFR) and examined the correlation between 
      the eGFR and preoperative factors (age, gender, number of urinary tract 
      infections [UTIs], primary diagnosis, reflux grade, percentage of 
      dimercaptosuccinic acid uptake, degree of renal parenchymal damage, s-Cr 
      abnormality, proteinuria, and hypertension), and analyzed the factors associated 
      with the long-term prognosis. RESULTS: The study population was 51 infants (37 
      boys and 14 girls). The mean age of the patients before surgery and at the 
      follow-up examination was 3.41 +/- 3.61 and 14.63 +/- 3.74 years, respectively. After 
      surgery, the s-Cr, urinary protein, and blood pressure values showed (44.7%, 
      26.7%, and 18.2%, respectively) were abnormal. The postoperative eGFR was a mean 
      90.27 +/- 20.42 ml/min/1.73 m(2) and primary correlated with an older age 
      (P = 0.0361), no UTI at the primary diagnosis (P = 0.0044), reflux grade >/=8 
      (P = 0.0180), degree of renal parenchymal damage (group >/=2b, P < 0.0001), s-Cr 
      abnormality (P < 0.0001), and proteinuria (P = 0.0001) at baseline. A total of 20 
      patients had chronic kidney disease (CKD; Fig. 1). The multiple regression 
      analysis of these factors revealed that an older age (P = 0.0021), reflux grade 
      >/=8 (P = 0.0134), and degree of renal parenchymal damage (group >/=2b, P < 0.0001) 
      were significantly associated with the long-term postoperative prognosis of 
      reflux nephropathy. Using these three factors, this study derived a multiple 
      regression equation estimating eGFR in the 10th year after surgery (Fig. 1). 
      DISCUSSION: In this study, severe vesico-ureteral reflux (reflux grade >/=8) and 
      severe renal parenchymal damage (group >/=2b) were associated with a long-term 
      decrease in the eGFR. In particular, renal parenchymal damage was closely 
      correlated with the postoperative eGFR; thus, this was clearly a critical factor. 
      The age at surgery showed a better correlation with the postoperative eGFR in the 
      multiple regression analysis; thus, age was regarded as an independent prognostic 
      factor. CONCLUSIONS: The age, reflux grade, and degree of renal parenchymal 
      damage at baseline were factors that affected the long-term postoperative 
      prognosis of reflux nephropathy. Patients with high-grade reflux and severe renal 
      parenchymal damage were more likely to show a reduced CKD level at 10 years after 
      anti-reflux surgery.
CI  - Copyright (c) 2019. Published by Elsevier Ltd.
FAU - Matsuoka, Hirofumi
AU  - Matsuoka H
AD  - Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan. 
      Electronic address: hmatsu57@fukuoka-u.ac.jp.
FAU - Tanaka, Masatoshi
AU  - Tanaka M
AD  - Department of Urology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
FAU - Yamaguchi, Takanori
AU  - Yamaguchi T
AD  - Department of Urology, Fukuoka Children's Hospital, Fukuoka, Japan.
FAU - Miyazato, Minoru
AU  - Miyazato M
AD  - Department of Urology, Graduate School of Medicine, University of the Ryukyus, 
      Okinawa, Japan.
FAU - Kihara, Toshiharu
AU  - Kihara T
AD  - Department of Urology, Graduate School of Biomedical Sciences, Nagasaki 
      University, Nagasaki, Japan.
FAU - Nakagawa, Masayuki
AU  - Nakagawa M
AD  - Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima 
      University, Kagoshima, Japan.
FAU - Mori, Ken-Ichi
AU  - Mori KI
AD  - Department of Urology, Faculty of Medicine, Oita University, Oita, Japan.
FAU - Kamimura, Toshio
AU  - Kamimura T
AD  - Department of Urology, Faculty of Medicine, University of Miyazaki, Miyazaki, 
      Japan.
LA  - eng
PT  - Journal Article
DEP - 20190827
PL  - England
TA  - J Pediatr Urol
JT  - Journal of pediatric urology
JID - 101233150
RN  - 0 (Biomarkers)
RN  - AYI8EX34EU (Creatinine)
SB  - IM
MH  - Adolescent
MH  - Biomarkers/blood
MH  - Child
MH  - Child, Preschool
MH  - Creatinine/blood
MH  - Female
MH  - Follow-Up Studies
MH  - *Forecasting
MH  - Glomerular Filtration Rate/physiology
MH  - Humans
MH  - Kidney/*diagnostic imaging
MH  - Kidney Diseases/blood/diagnosis/*etiology
MH  - Male
MH  - Postoperative Complications/diagnosis/*etiology
MH  - Retrospective Studies
MH  - Urography
MH  - Urologic Surgical Procedures/*adverse effects
MH  - Vesico-Ureteral Reflux/*surgery
OTO - NOTNLM
OT  - Anti-reflux surgery
OT  - Long-term prognosis
OT  - Reflux nephropathy
OT  - VUR
EDAT- 2019/10/02 06:00
MHDA- 2020/11/04 06:00
CRDT- 2019/10/02 06:00
PHST- 2018/12/12 00:00 [received]
PHST- 2019/08/20 00:00 [accepted]
PHST- 2019/10/02 06:00 [pubmed]
PHST- 2020/11/04 06:00 [medline]
PHST- 2019/10/02 06:00 [entrez]
AID - S1477-5131(19)30252-9 [pii]
AID - 10.1016/j.jpurol.2019.08.015 [doi]
PST - ppublish
SO  - J Pediatr Urol. 2019 Dec;15(6):605.e1-605.e8. doi: 10.1016/j.jpurol.2019.08.015. 
      Epub 2019 Aug 27.