Reflux nephropathy

Reflux nephropathy
Kidney has moderate hydronephrosis with scarring at lower pole, consistent with reflux nephropathy
SpecialtyUrology

Reflux nephropathy is kidney damage (nephropathy) due to urine flowing backward (reflux) from the bladder toward the kidneys; the latter is called vesicoureteral reflux (VUR). Longstanding VUR can result in small and scarred kidneys during the first five years of life in affected children. The end results of reflux nephropathy can include high blood pressure, excessive protein loss in the urine, and eventually kidney failure.

When reflux nephropathy is suspected as a cause of kidney disease, other conditions to consider include chronic pyelonephritis, obstructive uropathy, and analgesic overuse.

The term "reflux nephropathy" was introduced in 1973.[1]

Signs and symptoms

The symptoms of reflux nephropathy are comparable to nephrotic syndrome and infection of the urinary tract, though some individuals may not exhibit any evidence (symptom) of reflux nephropathy.[2]

Cause

The abnormal retrograde flow of urine from the bladder into one or both the ureters leads to vesicoureteral reflux (VUR), which is a direct consequence of incompetent and mislocated ureterovesical valves. Reflux nephropathy is a direct consequence of VUR or other urologic congenital anomalies stemming from chronic high-pressure sterile urine reflux and often leads to recurrent urinary tract infections (UTIs) in the early childhood.[3]

Pathophysiology

The underlying calyces lose their normal concave shape and show clubbing.

Diagnosis

It is diagnosed by micturating cystography; scarring can be demonstrated by ultrasound or DMSA.

Prognosis

Children with reflux nephropathy have higher risk of developing kidney scarring and hypertension in later life.[4]

Treatment

The aim of treatment is to reduce renal scarring. Those children with grade II or worse should receive low dose prophylactic antibiotics (Nitrofurantoin, trimethoprim, cotrimoxazole, cefalexin in those with CRF). Hypertension should be managed with ACE inhibitor or ARBs. Other treatment modalities include surgery (endoscopic injection of collagen behind the intra-vesical ureter, ureteric re-implantation or lengthening of the submucosal ureteric tunnel) which has its protagonists.

Epidemiology

There is a genetic predisposition, first-degree relatives have a great increase in the chance of VUR. The gene frequency is estimated to be 1:600. The American Academy of Pediatrics recommends that children from 2 to 24 months presenting with a UTI should be investigated for VUR.

References

  1. ↑ Dillon MJ, Goonasekera CD (December 1998). "Reflux nephropathy". J. Am. Soc. Nephrol. 9 (12): 2377–83. PMID 9848795. Archived from the original on 2022-05-20. Retrieved 2022-05-11.
  2. ↑ "Reflux nephropathy: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Archived from the original on 2015-11-24. Retrieved 2015-11-24.
  3. ↑ Aeddula NR, Baradhi KM. Reflux Nephropathy. [Updated 2018 Sep 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526055/ Archived 2022-05-20 at the Wayback Machine
  4. ↑ Goonasekera CD, Dillon MJ (August 1998). "Reflux nephropathy and hypertension". Journal of Human Hypertension. 12 (8): 497–504. doi:10.1038/sj.jhh.1000653. PMID 9759982.

Further reading

Classification
External resources
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