Learning from History Or the Rationale for Considering Surgical Correction of Vesicoureteral Reflux (Point/Counterpoint) (Clinical Report‪)‬

Author(s): Jonathan Riddell, MD, FRCSC, Julie Franc-Guimond, MD, FRCSC History reminds us of valuable lessons learned in the treatment of vesicoureteral reflux (VUR). Rates of reflux nephropathy (RN) have decreased remarkably over the past 50 years, owing in various degrees to more rapid detection of urinary tract infection (UTI) in infants and children, improved medical therapy and timely surgical intervention. Reflux nephropathy once accounted for 22% of all pediatric renal transplantations, and now accounts for less than 6%.[sup.1] Despite this improvement, 8.5% of chronic renal disease in North American children is still due to RN.[sup.2] In some series, there is a history of childhood pyelonephritis with subsequent renal scarring in up to 15% of adult renal transplantation.[sup.3] Therefore, the modern day debate on the optimal management of VUR has significant merit in terms of preventing RN, and its impact on pediatric and adult populations.