REFLUX NEPHROPATHY
Vesicoureteric reflux (VUR) is the back flow of urine from the
bladder to the ureter; and reflux nephropathy (RN) is the kidney disease
characterized by coarse renal scars as a complication of VUR.
Pathogenesis of Renal scarring in RN:
Renal scars develop during infancy or during early childhood.
Three factors are interacting to cause renal scarring. These are:
- Vesicoureteric reflux.
- Intra-renal reflux.
- Urinary infection. As infection reaches renal pyramids in the
immature kidney, scars will develop.
Prevalence of RN:
About 0.5% of neonates have VUR, but small proportion of them
develop R.N., scarring occurs in female more than in male (5 : 1).
1-2% of school girls have bacteruria, and of these 20-30% have
VUR. Prevalence of RN in school girls is 0.3-0.5%.
Clinical Features:
- Recurrent urinary tract infections: This is the commonest
presentation. In neonates it may present as fever and failure to
thrive, in older children it is associated with fever, dysuria,
frequency and loin pain. Usually it is recurrent. - Hypertension: VUR is responsible for more than 60% of
hypertension in children and 60% of adults with VUR are
hypertensive.