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END STAGE 32 CASES OSCAR SALVATIERRA, JR.*
AND
EMIL A. TANAGHO
From the Department of Surgery and the Division of Urology, University of Califomia School of Medicine, San Francisco, Califomia
ABSTRACT
Of 32 patients with end stage renal failure secondary to bilateral, primary, low pressure',reflux 10 had sterile reflux and 22 had reflux associated with recurrent urinary tract infection. These cases clearly document a potential terminal phase in the natural history ofreflux. In addition, the study indicates the absolute necessity of early diagnosis and surgical correction of severe regardless of whether the reflux is sterile or associated with infection, and before chemical evidence of renal functional impairment. End stage renal failure is a potential terminal phase in the natural history of severe vesicoureteral reflux.' However, the role that primary vesicoureteral reflux plays by itself in the pathogenesis of renal functional impairment appears unclear. The purpose of our report is to document that infected or sterile primary reflux can result in renal failure. CLINICAL MATERIAL
Of 965 referred to our hospital for renal transplantation 47 per cent) had documented vesicoureteral reflux, 32 ofv1hom (3,3 per cent) had bilateral, primary, low pressure reflux. These cases form the basis of this report. The remaining 15 patients were not included in the study because they failed to satisfy criteria for bilateral, primary, low pressure reflux. Reflux in 9 of the 15 patients was secondary to other conditions, such as posterior urethral valves, while it was unilateral or high pressure in the other 6 cases. However, bilateral end stage chronic pyelonephritis occurred after repeated urinary tract infection in all 15 patients. THE STUDY
The 32 patients in our study had end stage renal failure and hemodialysis vvas necessary to maintain life. Bilateral, low pressure, vesicoureteral reflux was shown retrograde cystography performed at least 1 time during each evaluation. Contrast medium filled the ureteral and gaping ureteral at operation or both. No neurologic or rn,TncrPn cause for reflux was evident. The average age of the patients at onset of end failure was 21.2 with a range of 5 to 38 years. 32 patients were into 2 groups: those with sterile reflux and those with reflux associated with tract infection (table 1). Patients with sterile reflux were who had not had previous urinar
END STAGE 32 CASES OSCAR SALVATIERRA, JR.*
AND
EMIL A. TANAGHO
From the Department of Surgery and the Division of Urology, University of Califomia School of Medicine, San Francisco, Califomia
ABSTRACT
Of 32 patients with end stage renal failure secondary to bilateral, primary, low pressure',reflux 10 had sterile reflux and 22 had reflux associated with recurrent urinary tract infection. These cases clearly document a potential terminal phase in the natural history ofreflux. In addition, the study indicates the absolute necessity of early diagnosis and surgical correction of severe regardless of whether the reflux is sterile or associated with infection, and before chemical evidence of renal functional impairment. End stage renal failure is a potential terminal phase in the natural history of severe vesicoureteral reflux.' However, the role that primary vesicoureteral reflux plays by itself in the pathogenesis of renal functional impairment appears unclear. The purpose of our report is to document that infected or sterile primary reflux can result in renal failure. CLINICAL MATERIAL
Of 965 referred to our hospital for renal transplantation 47 per cent) had documented vesicoureteral reflux, 32 ofv1hom (3,3 per cent) had bilateral, primary, low pressure reflux. These cases form the basis of this report. The remaining 15 patients were not included in the study because they failed to satisfy criteria for bilateral, primary, low pressure reflux. Reflux in 9 of the 15 patients was secondary to other conditions, such as posterior urethral valves, while it was unilateral or high pressure in the other 6 cases. However, bilateral end stage chronic pyelonephritis occurred after repeated urinary tract infection in all 15 patients. THE STUDY
The 32 patients in our study had end stage renal failure and hemodialysis vvas necessary to maintain life. Bilateral, low pressure, vesicoureteral reflux was shown retrograde cystography performed at least 1 time during each evaluation. Contrast medium filled the ureteral and gaping ureteral at operation or both. No neurologic or rn,TncrPn cause for reflux was evident. The average age of the patients at onset of end failure was 21.2 with a range of 5 to 38 years. 32 patients were into 2 groups: those with sterile reflux and those with reflux associated with tract infection (table 1). Patients with sterile reflux were who had not had previous urinar
