Primary vesicoureteral reflux mediated renal scarring after urinary tract infection in Thai children.

Aim: To evaluate the association between primary vesicoureteral reflux (VUR) and renal scarring in children using 99 m Technetium-labelled dimercaptosuccinic acid (DMSA). Methods: Children attending at Songklanagarind Hospital from 1987 to 2002 were evaluated. Results: Ages at diagnosis of VUR in 46 boys and 52 girls were 1.1 ± 1.6 and 2.9 ± 2.5 years, median 0.6 and 2.3 years, respectively ( P < 0.001). DMSA scans were performed at 4.1 ± 3.6 years. Renal parenchymal damage was detected in 34 kidneys (22%) of 154 demonstrated refluxing ureters, and one kidney (2%) of 42 non-refluxing ureters ( P = 0.002). Of 79 refluxing ureters in boys and 75 refluxing ureters in girls, there were 25 and nine renal scars, respectively (32% and 12%, P = 0.003). Renal scars in VUR grades I–V were 11%, 7%, 12%, 44% and 64%, respectively ( P < 0.001). Multivariate analysis revealed that high grade VUR ( P < 0.001), age of diagnosis of VUR greater than 5 years ( P = 0.001), and male gender ( P = 0.002) were the most significant risk factors for renal scarring. Conclusion: High-grade VUR, age of diagnosis of VUR greater than 5 years and male gender were the most significant risk factors for renal scarring. [ABSTRACT FROM AUTHOR]