Reflux nephropathy

Associate Editor-In-Chief:

Overview
Reflux nephropathy, RN is a term applied when small and scarred kidneys (chronic pyelonephritis, CPN) are associated with vesico-ureteric reflux (VUR). CPN being the commonest cause, there are other causes including analgesic nephropathy and obstructive injury. Scarring is essential in developing RN and occurs almost during the first five years of life. The end results of RN are hypertension, proteinuria, CRF and eventually ESRD, end stage renal disease.

Diagnosis
It is diagnosed by micturating cystography, scarring can of course be demonstrated by ultrasound or DMSA.

Incidence/prevalence
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. All children with UTI should be investigated for VUR.

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, co-trimoxazole, cefalexin in those with CRF). Hypertension should be managed with ACE inhibitors or ARB's. Other treatment modalities also 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.