Hormones – Cytokines – Signaling
Kidney International (2003) 64, 1643–1647; doi:10.1046/j.1523-1755.2003.00278.x
Role of plasma renin activity in the management of primary vesicoureteric reflux: A preliminary report
Minu Bajpai, Kamlesh Pal, Chandrashekhar S Bal, Arun K Gupta and Ravinder M Pandey
Department of Paediatric Surgery, Department of Nuclear Medicine, Department of Radiodiagnosis, and Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
Correspondence: Dr Minu Bajpai, M.S., M.Ch., Ph.D., Diplomate of the National Board, Additional Professor, Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. E-mail: bajpai2@hotmail.com
Received 5 April 2003; Revised 4 June 2003; Accepted 1 July 2003.
Abstract
Role of plasma renin activity in the management of primary vesicoureteric reflux: A preliminary report.
Background
Nonoperative management is the choice of therapy in most patients with primary vesicoureteric reflux (VUR). Such patients are regularly monitored for breakthrough urinary tract infection, deterioration of renal function, and progression/ appearance of new scars as the indicators for switching over to surgical intervention. In this descriptive study, we report our additional observations on serial measurement of plasma renin activity (PRA) in a group of such children followed prospectively.
Methods
Twenty-six children (16 males and 10 females) with various grades (grades I to V) of primary VUR were enrolled. Besides the conventional investigations, we also monitored PRA. Ureteric reimplantation was performed based on established international criteria. PRA levels were correlated with the need for surgical intervention retrospectively.
Results
Mean age at presentation was 39.3 months (range, 12 to 120 months). Nineteen children (73%) were subjected to ureteric reimplantation. The mean PRA in this group (N = 19) was 6.97 ng/mL/hour versus 3.28 ng/mL/hour in patients who were continued on nonoperative management (N = 7). Postoperatively, the PRA reduced and stabilized in all 18 patients at a mean value of 5.4 ng/mL/hour.
Conclusion
The currently accepted end points of medical management are inconsistent. On the other hand, 94.7% of children in the surgical group had shown an activation and a progressive increase in PRA. Postoperatively, the PRA was reduced and stabilized in all these patients. Our preliminary observations suggest that high PRA is a more sensitive indicator for surgical intervention as compared to the existing criteria.
Keywords:
vesicoureteric reflux, renin, renal scars, ureteric reimplantation, congenital uropathy, reflux nephropathy
