Reflux nephropathy is kidney damage caused by chronic backward flow of urine. It can be congenital or acquired, and risk factors include urinary tract abnormalities and recurring infections. Treatment varies depending on severity and damage. Tests and imaging are needed for diagnosis. Mild reflux can be treated with antibiotics and antihypertensive drugs, while severe cases may require surgery.
Reflux nephropathy (RN) is a condition in which the kidneys are damaged due to the chronic backward flow of urine in the kidneys. Reflux can occur unilaterally or bilaterally, and the damage from scarring or atrophy can involve one or both kidneys, leading to chronic renal failure. It can be congenital or it can occur with acquired conditions that lead to urine flow obstruction. Risk factors for reflux nephropathy include a personal or family history of urinary reflux, urinary tract abnormalities, and recurring urinary tract infections. Treatment for this condition varies depending on the severity of the reflux and the damage to the kidney.
This condition is a relatively common form of chronic pyelonephritic scarring. It occurs in young children as a result of a urinary tract infection superimposed on congenital intrarenal reflux and vesicoureteral reflux. When there is severe obstruction, vesicoureteral reflux can occasionally cause reflux nephropathy even in the absence of infection. Acquired conditions that lead to urinary outflow obstruction and ultimately reflux nephropathy if not treated immediately are bladder stones, bladder outlet obstruction, and neurogenic bladder. Trauma or swelling of the ureter can also cause reflux nephropathy.
An individual with this condition may be asymptomatic or symptomatic. Symptomatic individuals have symptoms similar to those of chronic kidney disease or a urinary tract infection. Symptoms of chronic kidney disease vary with the degree of severity and are usually nonspecific, but most people with this disease have high blood pressure. Urinary tract infection usually produces symptoms of painful urination, blood in the urine, back pain and urinary frequency, urgency and hesitation. Children with recurrent urinary tract infections should be suspected of reflux nephropathy.
Several tests are needed to confirm this condition. These include tests for blood and urine as well as imaging modalities. Blood and urine tests are serum urea nitrogen (BUN), serum creatinine, creatinine clearance, urinalysis, and urine culture. Imaging modalities that may be done to demonstrate reflux are ultrasonography of the kidneys, simple or delayed cystography, radionuclide cystogram, or voiding cystourethrogram.
Treating conditions that cause urine reflux can prevent reflux nephropathy. Mild reflux can be treated medically. Your doctor will prescribe antibiotics to prevent infections and antihypertensive drugs, especially angiotensin-converting enzyme and angiotensin receptor blockers, to delay kidney damage by controlling blood pressure. Individuals undergoing medical therapy should be monitored regularly and have regular urine cultures and an annual renal ultrasound. People with severe reflux and those who are unresponsive to medical therapy are treated surgically through ureteral implantation or reconstructive repair.
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