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Titolo:
Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial
Autore:
Smellie, JM; Barratt, TM; Chantler, C; Gordon, I; Prescod, NP; Ransley, PG; Woolf, AS;
Indirizzi:
Univ Coll London, Great Ormond St Hosp Children NHS Trust, London WC1N 1EH, England Univ Coll London London England WC1N 1EH Trust, London WC1N 1EH, England Univ Coll London, Inst Child Hlth, London WC1N 1EH, England Univ Coll London London England WC1N 1EH Hlth, London WC1N 1EH, England Univ London Kings Coll, Guys Hosp, Sch Dent, London WC2R 2LS, England UnivLondon Kings Coll London England WC2R 2LS London WC2R 2LS, England Univ London Kings Coll, Guys Hosp, Sch Med, London WC2R 2LS, England Univ London Kings Coll London England WC2R 2LS London WC2R 2LS, England Univ London Kings Coll, St Thomas Hosp, Sch Med, London WC2R 2LS, England Univ London Kings Coll London England WC2R 2LS London WC2R 2LS, England Univ London Kings Coll, St Thomas Hosp, Sch Dent, London WC2R 2LS, EnglandUniv London Kings Coll London England WC2R 2LS London WC2R 2LS, England
Titolo Testata:
LANCET
fascicolo: 9265, volume: 357, anno: 2001,
pagine: 1329 - 1333
SICI:
0140-6736(20010428)357:9265<1329:MVSTIC>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
URINARY-TRACT INFECTION; INTERNATIONAL REFLUX; EUROPEAN BRANCH; RENAL SCARS; 5-YEAR; ACID;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
29
Recensione:
Indirizzi per estratti:
Indirizzo: Barratt, TM Univ Coll London, Great Ormond St Hosp Children NHS Trust, London WC1N 1EH, England Univ Coll London London England WC1N 1EH n WC1N 1EH, England
Citazione:
J.M. Smellie et al., "Medical versus surgical treatment in children with severe bilateral vesicoureteric reflux and bilateral nephropathy: a randomised trial", LANCET, 357(9265), 2001, pp. 1329-1333

Abstract

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 years' follow-up we estimated GFR from the plasma clearance of Cr-51-labelled edetic acid (EDTA), and did intravenous urography. We also did a metastable Tc-99m-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 availablefor 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 m(2) (SD 24.1) in the medical and 71.7 mL/min per 1.73 m(2) (22.6) in the surgical group. Themean percentage change in Gm 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.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 23/09/20 alle ore 12:17:51