Role of endoscopic treatment of vesico-ureteric reflux in downgrading renin angiotensin system activation

ObjectivesThe objective of this study was to assess the role of endoscopic treatment of vesico-ureteric reflux (VUR) in downgrading renin angiotensin system (RAS) activation.MethodsOf 115 patients diagnosed and treated for VUR, 63 underwent hyaluronic acid/dextranomer (deflux) injection in a total of 99 ureteric moieties. Patients were monitored for urinary tract infection (UTI), glomerular filtration rate (GFR), plasma renin activity (PRA), renal scarring, persistence, or appearance of contra-lateral reflux.ResultsGrade III VUR was most common (38%), and the most common cause of VUR was primary (60%). Analysis of patient characteristics at presentation revealed increased PRA in most cases (68%). Grade I VUR showed the most avid decrease in serum PRA levels after single injection. Serum PRA levels were sustainably low in patients of grade I and II VUR, whereas in patients of grade III values kept rising after reaching nadir. This increase in PRA levels correlated well with persistence of symptoms and reappearance of VUR in some patients.ConclusionPRA levels can be used as an indicator to initiate treatment of VUR. They can also be used for monitoring the progress of the disease and efficacy of the treatment given.