Long-term Conservative Follow-up in Children with High-grade Vesicoureteral Reflux and an Abnormal Dimercaptosuccinic Acid Scan

Materials a n d MethodsThis was a retrospective study.Children with high-grade VUR and abnormal DMSA scans who were followed up in a Pediatric Nephrology clinic had their details recorded.The clinical details of these patients with a follow-up of 3 to 19 years were looked at from 1 st January 2022 to 30 th June 2022.The children have been following the management plan as given below.All children who had been identified as having high-grade VUR (grades 4 and 5) subsequent to having a micturating introduction Urinary tract infections are a common problem in children, and it is believed that 1% of children suffer from a urine infection (UTI) by 8 years of age. 1 Identifying risk factors for the prevention of UTIs has always been the primary aim to prevent kidney damage from recurrent UTIs.Vesicoureteral reflux (VUR) has been considered an important risk factor for recurrent UTIs.There has been a huge debate about the management of VUR, with options ranging from conservative management with antibiotic prophylaxis to surgery.VUR has been shown to have five grades, with grades 4 and 5 associated with dilated ureters representing high-grade VUR.Literature has shown that conservative management of VUR is possible, 2,3 but about 15 years or more in the past when the children in the study were first seen, surgery for high-grade VUR was not uncommon, especially in India.In fact, every child in this study had surgery recommended!Similarly, in most parts of India, even today, high-grade VUR, especially associated with an abnormal dimercaptosuccinic acid (DMSA), is still being recommended for surgery!Surgery is advocated, presuming that these children are prone to develop recurrent infections, and even in unilateral VUR, it is done to prevent damage to the "other" normal kidney.This study looks at the long-term outcome in children with high-grade VUR who also had an abnormal DMSA scan.