Effect of Vesicoureteral Reflux on Renal Growth

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Abstract
The renal ratio (renal length/length of L2 [2nd lumbar vertebra] plus its disk) of 99 kidneys in children with reflux and both kidneys of 51 adults with reflux was calculated and compared to mean and standard deviations of normal renal ratio for age. Of the 99 kidneys in children with reflux, 16% were smaller than minus 2 SD on the initial excretory urograms. Seventy-six kidneys with reflux were then studied and normal renal growth occurred in 68%. The renal ratio of 8% declined temporarily below minus 2 SD but these kidneys exhibited accelerated growth and resumed a normal renal ratio as soon as spontaneous cessation or improvement of reflux occurred. Another 8% deteriorated gradually, resulting in a small kidney ratio below minus 2 SD. The renal ratio of 16% remained persistently below minus 2 SD throughout the period of study. The majority of those kidneys with impaired growth represented grade 3 reflux, grade 3 ureteral orifice and abnormality on excretory urography but, despite normal excretory urography or sterile urine, impaired renal growth was observed in some instances. Three patients in whom both kidneys were small showed a moderate decrease in total renal function. Of the kidneys with reflux in adults the renal ratio was below minus 2 SD in 36%. Of the 23 patients in whom 1 or both kidneys were small 8 (34.8%) were uremic. The 4 cases of 2 small kidneys had uremia. When the renal ratio was minus 2 SD of normal renal ratio an antireflux operation was preferable. Careful attention to renal growth was important in the management of children with relfux, especially those with grade 3 reflux or grade 3 orifice, despite sterile urine or normal excretory urography. Such cases should be treated surgically before the kidneys become smaller than minus 2 SD.