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- Köhler, Jan, et al.
(författare)
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Long-term effects of reflux nephropathy on blood pressure and renal function in adults.
- 2003
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Ingår i: Nephron Clinical Practice. - : S. Karger AG. - 1660-2110. ; 93:1, s. 35-46
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Tidskriftsartikel (refereegranskat)abstract
- <i>Aims:</i> We investigated whether the grade of renal damage assessed by urography in adult patients with vesicoureteral reflux can be used to identify patients at risk of developing hypertension and/or deterioration of renal function. In addition, maternal and fetal outcome of pregnancy was studied. <i>Methods:</i> Vesicoureteral reflux was diagnosed at a median age of 27 years (range 16–60) in 115 patients (98 women). Excluding patients subjected to nephrectomy or heminephrectomy after inclusion (n = 12), 88 patients had renal damage at inclusion urography and a median follow-up time of 16 years. The median follow-up time was 18 years in 15 patients without renal damage. Grading of renal damage was performed and blood pressure, serum creatinine concentration and albuminuria were measured. Hypertension was considered to be present if the systolic blood pressure was ≧140 mm Hg and/or the diastolic blood pressure was ≧90 mm Hg. It was classified as mild (<180 mm Hg systolic and <105 mm Hg diastolic), or moderate to severe (≧180 mm Hg systolic and/or ≧105 mm Hg diastolic). Renal function was classified as stable or deteriorating. <i>Results:</i> There was no significant difference in the frequency of hypertension among those with (52%) or without (33%) renal damage, but moderate to severe hypertension (16 patients) was only seen in patients with renal damage. Median systolic and diastolic blood pressure were higher in patients with than in those without renal damage. Malignant hypertension developed in 4 patients, all had extensive renal damage. Deterioration of renal function occurred in 25 patients, 1 with unilateral and 24 with extensive renal damage (bilateral or in a solitary kidney). This was associated with a high frequency of hypertension (92%) and albuminuria (88%). Sixteen patients developed end-stage renal disease. A total of 242 pregnancies occurred in 89 of the 98 women. Preeclampsia occurred in 16 (18%) women. <i>Conclusion:</i> Hypertension in adult patients with reflux nephropathy occurs with any grade of renal damage, whereas deterioration of renal function was strongly associated with extensive bilateral renal damage or damage in a solitary kidney.
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| 2. |
- Köhler, Jan
(författare)
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Long-term outcome of vesicoureteral reflux and reflux nephropathy in adults - clinical and radiological aspects
- 2001
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim was to study the long-term consequencies of vesicoureteral reflux and reflux nephropathy (RN) in adults, with regard to radiological progression, urinary tract infections, renal functional impairment, hypertension, and to determine if the extent of renal damage can predict the outcome. Attempts to differentiate between acquired and developmental renal damage were also made. 115 patients with reflux were identified at a median age of 28 years and were followed clinically and radiologically for a median of 16 years. Half of the patients had antireflux surgery performed. Urographic renal damage was graded and related to the clinical outcome. Renal damage was found in 87% of the patients, and a history of acute pyelonephritis (APN) in 72%. Urographic and histological (n=25) analyses did not reveal maldevelopment as a cause of renal damage, but a family history of urinary tract disorders was common, suggesting that genetic factors are of importance. Renal function deteriorated in 25 patients and 16 reached end-stage renal disease. Urographic progression of renal damage occurred in only 4 of 120 kidneys, despite APN and persisting reflux. Therefore, repeated urography in adults with RN is rarely justified. Antireflux surgery in adults appears beneficial in relieving loin pain, but did not prevent renal functional deterioration, and reduction in APN frequency was comparable with that of conservative treatment. Urographic grading of renal damage can predict the risk of deterioration of renal function, but not of hypertension. Early detection and treatment of APN in childhood appear to be important measures in the long-term prevention of renal damage and subsequent functional deterioration.
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