Godley, Margaret Lesley; (1991) Effects of sterile vesicoureteric reflux on renal growth and function. Doctoral thesis (Ph.D), University of London, Institute of Cancer Research.

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Abstract

Vesicoureteric reflux (VUR) is predominantly a disorder of childhood associated with urinary infection and renal scarring. It is recognised that, in the absence of urinary infection, scarring can be avoided despite continuing VUR; however, the effects of VUR per se on the growing kidney are unknown and this question formed the primary concern of this thesis. The effects of sterile VUR on renal growth and function in the absence of scarring were investigated in young pigs from soon after birth to about 6 months of age. Two parallel experiments were performed in pig models with either a solitary kidney following unilateral nephrectomy (Experiment I) or with paired kidneys(Experiment II). In both experiments the effects of VUR were examined in the presence of both normal and abnormal bladder function by including pigs with and without bladder outflow obstruction, as well as appropriate 'non-refluxing' controls. Bladder function was assessed by urodynamic studies. Renal growth was measured from the weight of the kidneys at the end of the study. Renal function was measured by 51Cr-Edetic acid glomerular filtration rate (GFR), urinary concentrating ability and renal uptake of 99mTc-dimercaptosuccinic acid (DMSA). Regression analysis was applied separately to the results from each experiment. There was no interaction between VUR and bladder function on any outcome measure and for each of them the 95% confidence intervals were calculated for the effects of VUR.In Experiment I, kidney weight and all parameters of renal function were examined. There was no significant effect of VUR on renal growth or GFR. The renal uptake of 99mTc-DMSA was reduced by VUR but was significant only at the 5% level. Urinary concentrating ability was significantly impaired by VUR (P<0.01). In Experiment II the effects of VUR on kidney weight and on uptake of 99rr>TC_DMSA were compared in pigs with and without unilateral VUR. There was no significant effect of VUR on relative uptake of 99mTc-DMSA or on relative kidney growth.

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