- Renal failure: 10% of patients coming for dialysis have RN,
usually at age of 30 years. Renal failure occurs due to scarring,
infection, and FSGS. - Other clinical presentations: As loin pain on voiding, childhood
enuresis, renal stone, positive family history, and presence of other
congenital anomaly as duplex ureter and posterior urethral valve.
Diagnosis:- IVU will show cortical scarring and clubbing of calyx, disparity in
kidney size and shape. - Renal radionuclear imaging. Using DMSA scan to show scarring or
area of inflammation. - MCU and cystoscopy.
- Renal biopsy is indicated only when IVU and DMSA show no
scarring.
Management of RN:
- Control of infection by prophylactic antibiotics which should be
given daily (e.g. septrin once daily) till puberty or reflux
disappears. If infection occurs it should be treated aggressively. - Control of hypertension.
- Anti-reflux surgery: The indication of surgery in treatment of VUR
is still controversial. Surgery will not prevent progression of renal
disease. It may be indicated with recurrent pyelonephritis or when
prophylactic antibiotics could not be given especially with high
grade reflux. Either ureter is reimplanted into the bladder with
special anti-reflux technique or cystoscopic injection of material
(e.g. collagen or polytetrafluoro- ethylene) around ureteric orifice
to narrow it and to prevent refluxing.