Study Targets Childhood Urinary Condition

BUFFALO, N.Y. -- Vesico-ureteral reflux, in which urine flows from the bladder back up the ureter to the kidneys, is diagnosed in 50,000 children annually in the U.S. Not only does the reversed urine flow cause recurrent urinary-tract infections that can lead to kidney damage, but in some cases the damage can result in hypertension and renal failure, either in childhood or later in adult life.

Optimum treatment for vesico-ureteral reflux (VUR) is the focus of a clinical trial, scheduled to begin this fall and involving several hundred children, that is being conducted by pediatric urologists at the University at Buffalo with a five-year, $2.5 million grant from the National Institutes of Health.

Saul Greenfield, M.D., clinical professor of urology in UB's School of Medicine and Biomedical Sciences and director of the Division of Pediatric Urology at Women and Children's Hospital of Buffalo, is principal investigator.

Treatment options for VUR include surgery, long-term antibiotic prophylaxis or observation. Greenfield said there are no well-established guidelines for all children with this condition and that many controversies remain.

"We have already shown in Buffalo that kidney disease and high blood pressure is reduced by early recognition and treatment of VUR," he said. "We hope to be able to learn more about how to handle reflux from this study. It might be possible to tailor treatment to children, so that not every child will need surgery or medication that has to be taken for many years.

"The Department of Pediatric Urology at Women and Children's Hospital of Buffalo has had a long-standing interest in this condition and has contributed substantially to the literature on this topic. We have conducted basic and clinical research and we are a regional referral center for Western New York. We are hopeful that lessons learned from this study will result in continued improvements in care and keep us on the cutting edge," said Greenfield.

Children in the study will be assigned randomly to different treatment groups and followed for three years. Wayne R. Waz, M.D., UB assistant professor of pediatrics and director of the Department of Pediatric Nephrology at Women and Children's Hospital of Buffalo, is co-investigator on the project.