MILD AND MODERATE VESICOURETERIC REFLUX IN CHILDREN

儿童轻度和中度膀胱输尿管反流

• 批准号: 3231290
• 负责人: BILLY S ARANT
• 金额: $ 6.53万
• 依托单位: UT SOUTHWESTERN MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 1983
• 资助国家: 美国
• 起止时间: 1983-09-30 至 1991-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/3231290
• 关键词: blood pressure; child (0-11); disease /disorder proneness /risk; glomerular filtration; human subject; hypertension; kidney disorder; scars; urinalysis

Renal injury from vesicoureteric reflux (VUR), or reflux nephropathy (RN), is a major cause of hypertension and end-stage renal disease and the only such cause which may be preventable. RN must have its onset in infancy or early childhood because renal scarring from VUR +UTI is observed rarely after childhood. While it is common to have renal scarring associated with severe grades of VUR, two prospective studies in children have found no benefit to early surgical correction of VUR over that of medical management. It has been assumed previously that mild and moderate (M/M) grades of VUR resolved spontaneously and were associated rarely with renal injury in the absence of UTI, but no such prospective study has been conducted to confirm this notion. Such a study was initiated 4 years ago with partial funding through NIH. The goals of the study are to observe over a 5 year follow-up period the evolution of M/M VUR by annual cystograms, to assess renal growth and injury by planimetric measurements from intravenous pyelograms at 1,3 and 5 years after diagnosis, to evaluate renal function by GFR, urinalysis and concentrating capacity, and to monitor blood pressure and measure plasma renin activity as predictors of hypertension in infants and young children < 5 years old at diagnosis and treated medically. When the study was closed to new patient entry, a total of 113 patients had been entered: 96 have completed first year, 59 second year and 21 third year follow up evaluations to date. While VUR improved or disappeared in 40% of ureters and only 2 previously normal kidneys had scars at 1 year (2/96 patients), 3 kidneys have scars and 5 others have exhibited poor growth or have evidence to suggest scarring at 3 years (8/21 patients); no relationship to the grade of VUR and scarring was observed in these patients. While all affected kidneys may be clustered in the first patients entered for the study, the importance of complete, long-term follow up of all patients is obvious. To accomplish this, the project must be funded adequately for 3 additional years. There has never been a similar prospective study of such a homogenous population with mild-moderate VUR. The conclusions of this study will either support current recommendations for conservative medical management of mild-moderate VUR in infants and young children or give reason to investigate management alternatives to reduce the incidence of serious consequences of a childhood disease which has its sequelae during adolescence and young adulthood.

膀胱输尿管反流(VUR)或反流性肾病(RN)造成的肾脏损伤， 是高血压和终末期肾病的主要原因，也是唯一 这样的原因是可以预防的。RN必须在婴儿期或 儿童早期，因为很少观察到VUR+UTI造成的肾脏疤痕 在童年之后。虽然与肾脏疤痕相关的疾病很常见 严重的VUR，两项针对儿童的前瞻性研究发现没有 输尿管返流早期手术矫治优于内科矫治 管理层。以前的假设是轻度和中度(M/M) VUR分级自发消退，很少与肾脏相关 在没有尿路感染的情况下的损伤，但还没有这样的前瞻性研究 为证实这一观点进行了调查。这项研究是4年前开始的。 通过美国国立卫生研究院提供部分资金。这项研究的目的是观察 在5年的随访期内，M/M VUR按年演变 用平面测量法评估肾脏生长和损伤的膀胱造影术 从确诊后1、3和5年的静脉肾盂造影来评估 肾功能通过肾小球滤过率、尿液分析和浓缩能力，以及 监测血压和测量血浆肾素活性作为预测高血压的指标 5岁婴幼儿高血压的诊断和治疗 接受医疗治疗的。 当这项研究停止接受新患者进入时，共有113名患者 入学人数：一年级96人，二年级59人，三年级21人 到目前为止的年度跟踪评估。当VUR改善或消失时 40%的输尿管和只有2个以前正常的肾脏在1年后有疤痕 (2/96例)，3个肾脏有疤痕，5个肾脏表现不佳 生长或有证据表明在3年内形成疤痕(8/21例患者)； 在这些患者中观察到了与VUR分级和瘢痕形成的关系 病人。虽然所有受影响的肾脏可能在第一批患者中聚集在一起 进入研究阶段，全面、长期跟踪调查的重要性 所有的病人都是显而易见的。要做到这一点，必须为该项目提供资金 足够再用3年。从未有过类似的 对这样一个具有轻、中度输尿管返流的同质人群的前瞻性研究。 这项研究的结论要么支持当前的建议 用于婴幼儿和婴幼儿轻、中度VUR的保守医学治疗 或给出理由调查管理替代方案 减少儿童疾病严重后果的发生率 在青春期和青春期有后遗症。