Razvoj dijagnostike i liječenja vezikoureteralnog refluksa u Hrvatskoj – crtice iz povijesti

Introduction: This paper presents a historical overview of the development of pediatric nephrology in Croatia, from the establishment of the first Department of Nephrology in 1957 at the Department of Pediatrics on Šalata to the end of the 20th century, with particular emphasis on the evolution of the diagnosis and treatment of vesicoureteral reflux (VUR). Objective: To present the key historical phases, the contributions of leading Croatian experts, and the transition from invasive radiological and surgical methods to less invasive diagnostic and therapeutic procedures. Methods: Historical data were collected through a review of the available professional and scientific literature, hospital monographs, and archival documentation, as well as from personal testimonies of physicians who directly participated in the development of pediatric nephrology in Croatia. The review covers the period up to the year 2000. Historical development: The Zagreb School, led by Prof. Vlatković and Prof. Batinić, introduced a new classification of VUR based on voiding cystourethrography (VCUG), cystoscopy, renal scintigraphy, and urography. The introduction of endoscopic treatment for reflux in the 1990s changed the therapeutic approach. The advent of ultrasound in the 1980s reduced the need for ionizing radiation. Urodynamic studies helped elucidate the importance of lower urinary tract function in the development and maintenance of VUR. The Rijeka Center distinguished itself through the early diagnosis of anomalies, the routine introduction of kidney biopsy, and the first pediatric kidney transplantation in 1972. Pediatricians from Split contributed by introducing direct radionuclide cystography (DRNC) in 1991, thereby sparing more than 60% of children from radiation exposure. Gradually, pediatricians with a special interest in urinary tract diseases emerged throughout Croatia, leading to the establishment of nephrology outpatient clinics and departments. Significant contributions to the development of the field were also made by the founders of Croatian nephropathology and pediatric dialysis. Conclusion: Thanks to the visionary work of its founders, Croatian pediatric nephrology successfully transitioned from predominantly surgical treatment of children with higher-grade reflux, X-ray diagnostics, and long-term prophylaxis for all children with VUR to the modern era of ultrasound, urodynamics, minimally invasive endoscopic treatment, tailored uroprophylaxis, and a personalized approach.