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[Clinical study of reflux nephropathy. I. Outcome of renal function in VUR patients with proteinuria].

Seventeen patients with primary vesicoureteral reflux and marked proteinuria (5.1 per cent of 334 patients with primary VUR treated between 1975 and 1984) have been followed clinically. Among them 11 patients underwent antireflux operations and 6 patients were observed conservatively. Their renal functions were followed by IVPs, radioisotope renograms and serum creatinine values. Except two child patients receiving antireflux operation who showed normal renal function preoperatively, in all of the remaining 15 patients their renal function deteriorated progressively, no matter whether they had undergone operations or not. 3 patients of them developed chronic renal failure and received hemodialysis or renal transplantation. Antireflux surgery had no beneficial effect on renal function and proteinuria except for control of urinary tract infection in these patients. On the other hand in most VUR patients without proteinuria the outcome of antireflux operation appears to be satisfactory even though renal scars were revealed on IVPs. Proteinuria seems to be a more reliable prognostic factor of renal deterioration than the presence of renal scar. We propose that vesicoureteral reflux should be prevented surgically before proteinuria and reflux nephropathy occur.