Predictors of Renal Dysfunction in Adults with Childhood Vesicoureteral Reflux after Long-Term Follow-Up

Smiljana Bundovska-Kocev; Dafina Kuzmanovska; Gjulsen Selim; Ljubica Georgievska-Ismail

doi:10.3889/oamjms.2019.078

Authors

Smiljana Bundovska-Kocev University Clinic of Radiotherapy & Oncology, Medical School, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
Dafina Kuzmanovska University Paediatric Clinic, Medical School, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
Gjulsen Selim University Clinic of Nephrology, Medical School, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia
Ljubica Georgievska-Ismail University Clinic of Cardiology, Medical School, University Ss. Cyril and Methodius of Skopje, Skopje, Republic of Macedonia

DOI:

https://doi.org/10.3889/oamjms.2019.078

Keywords:

Childhood vesicoureteral reflux, Renal dysfunction, Chronic renal failure, Predictive risk factors

Abstract

BACKGROUND: Triad of childhood vesicoureteral reflux (VUR), urinary infection (UTI) and renal scarring might initiate potentially serious consequences that lead to renal dysfunction manifested at the second or third decade of life.

AIM: To identify the risk factors predictive for renal dysfunction in adults with primary VUR after long-term follow-up.

METHODS: We evaluated the records of 101 children (94.1% female, 5.9% male) at a median age of 5.2 Â± 2.3 years (1-12 years), suffering from UTI and VUR. The patients were interviewed after mean 21 years from the first episodes of VUR (8 to 32 years). Renal function was determined from the estimated glomerular filtration rate (eGFR).

RESULTS: Renal scarring was detected in 68.3% out of 82 patients and bilateral one in 7.3% patients. Linear regression analysis revealed that presence of proteinuria (B = -33.7, p=0.0001), the greater number of years from VUR diagnosis (B = -1.6, p = 0.002) and renal scarring (B = -14.8, p = 0.005) appeared as independent predictors of reduced global eGFRcreat. The same variables plus microalbuminuria (B = -1.0, p = 0.012) appeared as independent predictors of reduced global eGFRcreat-cys. Bilateral scarring (OR=25.5, p = 0.003) appeared as independent predictor of greater risk for CKD assessed using eGFRcreat while greater number of years from VUR diagnosis (OR = 1.7, p = 0.092), microalbuminuria (OR = 1.3, p = 0.047) and again bilateral scarring (OR = 31.3, p = 0.040) appeared as predictors of risk for CKD assessed using eGFRcreat-cys.

CONCLUSION: Identification of those with an increased risk of progression to CKD should be the goal in all patients with childhood VUR. Their systematic follow-up should be till adulthood and older age.

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