LAUSR

Objective To study the association between the grade of reflux and urinary tract infections (UTIs) and renal scarring at the first clinical presentation of patients who underwent anti-reflux surgery. Methods Between 2010 and 2017, 150 patients (194 renal units) who underwent anti-reflux surgery, had dimercaptosuccinic acid (DMSA) renal scans preoperatively (retrospective study). The patients were classified into non-scar and scar groups according to the DMSA scan results. Moreover, cases were classified into afebrile UTI, febrile UTI, and antenatal hydronephrosis (ANH) according to the mode of presentation. We correlated the mode of presentation and the grade of reflux to the presence/absence of renal scars in both groups. Grading of reflux was (I–V) according to the International Reflux Study Committee 1987. Results The mean follow-up was 45 months. The mode of presentation was afebrile, febrile UTIs and ANH in (50, 14) (20, 46) and (10, 10) in the non-scar and scar groups, respectively. Of the 20 patients who presented with ANH, 10 (50%) had scars. The mode of clinical presentation was correlated to the presence of renal scarring and its degree. The scar group had significantly higher grades of vesico-ureteric reflux than the non-scar group; grades I–II [40 patients, 50 units vs eight patients, 10 units], grade III [24 patients, 28 units vs 30 patients, 40 units] and grade IV–V [16 patients, 22 units vs 32 patients, 44 units] for the non-scar vs scar groups, respectively ( = 0.005). Conclusion Renal scarring is linked to higher grades of reflux and UTIs. We advocate proper investigations of infants who have UTIs with or without fever for early detection of reflux.