소아 방광요관 역류 207례에 대한 임상적 연구

Abstract

Vesicoureteral reflux is a complex phenomenon in which urine in bladder is refluxed to the upper ureter and intrarenal reflux cause renal damage and eventually to chronic renal failure. Thus we reviewed the patients with vesi- coureteral reflux to describe the clinical manifestations and treatment of vesicoureteral reflux in children and to help pediatricians detect and manage these pateints properly. We studied ret- rogradely the clinical features, laboratory and radiologic findings and treatment modalities of patients who were diagnosed to vesicoureteral reflux in our hospital from 1985 to 1994. The 207 patients ranged in age from 1 month to 15 years(mean 3.9 years) and male to female ratio was 1.3:1. The 135(65%) of 207 had fever at presentation and other major clinical manifesta- tions were urinary frequency(31), abdominal or flank pain(30), dysuria(25). Escherichia coli was the most common offending organisrn of urinary tract infection and other organisms were also detected including Klebsiella pneumoniae, Entero- coccus faecalis. Among the 321 renal units, 98 were grade IV and others were grade III(93), grade V(70), grade II(42), grade I(18). Nine- teen of 207 had dysplastic kidney as associated anomalies of vesicoureteral reflux and other anomalies were posterior urethral valve(9), ure- thral stricture(9), imperforete anus(9), myelome ningocele(7). Among the 260 renal units which were able to follow up after treatment, 47(90 of 52 who were treated conservatively im- proved and 148(71%) of 208 who were under- gone surgical treatment improved. Renal scarring was detected in 201(63% ) of 321 renal units. Thirteen patients were diagnosed to chronic renal failure and among them 12 were under- gone renal transplantation. These results suggest that clinical manifestations of vesicoureteral reflux is diverse and early detection with proper management is essential in preventing chonic renal failure.