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Prognostic Indicators for Treatment and Survival

Richard E. Berger, MD; Julian S. Ansell, MD; David B. Shurtleff, MD; Robert O. Hickman, MD

JAMA. 1981;246(1):56-59.

Abstract
To define factors related to renal prognosis in children with vesicoureteral reflux and renal insufficiency, we reviewed 908 children with vesicoureteral reflux. Twenty-five patients were found who had initial creatinine clearances of less than 60 mL/min/sq m and had five-year follow-up examinations. All had severely dilated ureters. Renal function improved in eight, remained stable in ten, and deteriorated in seven. Probability of deterioration of renal function in these children was related to factors measurable at clinical presentation: (1) a corrected creatinine clearance of less than 25 mL/min/sq m; (2) 2+ or greater reaction for protein on urinalysis that disclosed no infection; and (3) being in less than the fifth percentile of body length. The total number of the three factors present in each patient was more significantly related to prognosis than any one factor.

(JAMA 1981;246:56-59)

Author Affiliations
From the Department of Urology (Drs Berger and Ansell) and Pediatrics (Drs Shurtleff and Hickman), University of Washington School of Medicine, University Hospital; and Childrens Orthopedic Hospital, Seattle.

Footnotes
Reprint requests to School of Medicine, Department of Urology, RL-10, University of Washington, Seattle, WA 98195 (Dr Berger).

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