Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial

Background Nephropathy associated with vesicoureteric reflux (VUR) and urinary tract infection can result in end-stage renal failure, hypertension, or both. Whether long-term VUR contributes to these outcomes is unknown. We compared, in a randomised trial, medical with surgical management of children with bilateral severe VUR and bilateral nephropathy. Methods We stratified by age and glomerular filtration rate (GFR) 25 boys and 27 girls aged 1–12 years and randomly assigned them to medical or surgical management. At enrolment and 4 yearsʹ follow-up we estimated GFR from the plasma clearance of 51Cr-labelled edetic acid (EDTA), and did intravenous urography. We also did a metastable 99mTc-labelled dimercaptosuccinic acid (DMSA) assay and contrast cystography. The change in GFR at 4 years, expressed as a percentage change between enrolment and 4 years, was available for 26 of 27 patients in the medical and 24 of 25 in the surgical group. We assessed GFR in 48 patients 10 years after enrolment. Findings Mean GFR at enrolment was 72·4 mL/min per 1·73 m2 (SD 24·1) in the medical and 71·7 mL/min per 1·73 m2 (22·6) in the surgical group. The mean percentage change in GFR at 4 years was -2·4% (SE 4·5) versus 4·7% (5·0) in the medical and surgical groups, respectively. The difference in change in GFR at 4 years between the two groups was not significant (7·1%, 95% CI -6·4% to 20·6%). Interpretation Our data do not lend support to the view that the outcome for renal function is improved by surgical correction of VUR in children with bilateral disease.