reflux nephropathy
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| field = Urology
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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.{{cite journal |vauthors=Dillon MJ, Goonasekera CD |title=Reflux nephropathy |journal=J. Am. Soc. Nephrol. |volume=9 |issue=12 |pages=2377–83 |date=December 1998 |pmid=9848795 |url=http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=9848795}}
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.{{Cite web|title = Reflux nephropathy: MedlinePlus Medical Encyclopedia|url = https://www.nlm.nih.gov/medlineplus/ency/article/000459.htm|website = www.nlm.nih.gov|accessdate = 2015-11-24}}
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.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/
Pathophysiology
The underlying calyces lose their normal concave shape and show clubbing.{{cn|date=April 2022}}
Diagnosis
It is diagnosed by micturating cystography; scarring can be demonstrated by ultrasound or DMSA.{{medical citation needed|date=November 2015}}
Prognosis
Children with reflux nephropathy have higher risk of developing kidney scarring and hypertension in later life.{{cite journal |vauthors=Goonasekera CD, Dillon MJ |title=Reflux nephropathy and hypertension |journal=Journal of Human Hypertension |volume=12 |issue=8 |pages=497–504 |date=August 1998 |pmid=9759982 |doi=10.1038/sj.jhh.1000653 |url=|doi-access=free }}
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.{{medical citation needed|date=November 2015}}
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.{{Citation needed|date=April 2010}}
References
{{Reflist}}
Further reading
- {{Cite book|title = Professional Guide to Diseases|url = https://archive.org/details/isbn_9780781778992|url-access = registration|publisher = Lippincott Williams & Wilkins|date = 2009-01-01|page=[https://archive.org/details/isbn_9780781778992/page/414 414]|isbn = 9780781778992|language = en|first = Lippincott Williams &|last = Wilkins}}
External links
{{Medical resources
| MeshID =
| DiseasesDB = 11209
| ICD10 = {{ICD10|N11.0}}, {{ICD10|N13.7}}-{{ICD10|N13.9}}
| ICD9 = {{ICD9|593.73}}
| ICDO =
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| MedlinePlus = 000459
| eMedicineSubj = radio
| eMedicineTopic = 597
}}
{{Nephrology}}
{{Medicine}}
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