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ARTICLE:
Jonathan C. Craig, Epi), PhD, Les M. Irwig, FFAPHM, PhD, John F. Knight, and L. Paul Roy
Does Treatment of Vesicoureteric Reflux in Childhood Prevent End-Stage Renal Disease Attributable to Reflux Nephropathy?
Pediatrics 2000; 105: 1236-1241 [Abstract] [Full text] [PDF]
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[Read P3R] Is it yes or no or do we not know?
R Kishore Kumar   (12 February 2001)

Is it yes or no or do we not know? 12 February 2001
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R Kishore Kumar,
Consultant Paediatrician
University of Tasmania, Burnie TAS 7320, Australia.

Send letter to journal:
Re: Is it yes or no or do we not know?

R.Kumar{at}utas.edu.au R Kishore Kumar

Dear Editor

The subject of VUR to prevent the ESRD has always been controversial. As the authors indicate, unless a randomised controlled trial is undertaken there won't be clear answers. On the other hand, the treatment of VUR even though it may or may not prevent the ESRD, does it prevent the late onset hypertension or not and the associated morbidities - how do we answer questions like this to the family and how do we answer it to ourselves. Is it more academic question and what do the general paediatricians like us do meantime? I think the answer to lots of these questions is we don't know. Until we know the answers clearly we should continue to treat the VUR aggressively (especially grade 3 and above) as they may not prevent the ESRD, they certainly will prvent or should prevent/reduce later morbidities. We don't do any harm by aggressive management, but we may do harm by leaving them with conservative management. Lot of these children may be lost for follow up which may complicate the issues of treatment.

The Royal Colleges of the respective countries should come out with recommendations each year with the available EBM for the use of the general paediatricians, otherwise it may only lead to more confusion with more controversies stemmming out in the literature.

With sincere regards Kishore

Dr.R.Kishore Kumar