Reflux nephropathy
Encyclopedia
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 most common 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.
The term was introduced in 1973.
, scarring can of course be demonstrated by ultrasound
or DMSA.
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.
s (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.
Pyelonephritis
Pyelonephritis is an ascending urinary tract infection that has reached the pyelum or pelvis of the kidney. It is a form of nephritis that is also referred to as pyelitis...
, CPN) are associated with vesico-ureteric reflux (VUR). CPN being the most common 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
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, proteinuria
Proteinuria
Proteinuria means the presence of anexcess of serum proteins in the urine. The protein in the urine often causes the urine to become foamy, although foamy urine may also be caused by bilirubin in the urine , retrograde ejaculation, pneumaturia due to a fistula, or drugs such as pyridium.- Causes...
, CRF and eventually ESRD, end stage renal disease.
The term was introduced in 1973.
Diagnosis
It is diagnosed by micturating cystographyCystography
In radiology and urology, a cystography is a procedure used to visualise the urinary bladder.Using an urinary catheter, radiocontrast is instilled in the bladder, and X-ray imaging is performed. Cystography can be used to evaluate bladder cancer, vesicoureteral reflux, bladder polyps, and...
, scarring can of course be demonstrated by ultrasound
Ultrasound
Ultrasound is cyclic sound pressure with a frequency greater than the upper limit of human hearing. Ultrasound is thus not separated from "normal" sound based on differences in physical properties, only the fact that humans cannot hear it. Although this limit varies from person to person, it is...
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.
The American Academy of Pediatrics recommends that children from 2 to 24 months presenting with a 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 antibioticAntibiotic
An antibacterial is a compound or substance that kills or slows down the growth of bacteria.The term is often used synonymously with the term antibiotic; today, however, with increased knowledge of the causative agents of various infectious diseases, antibiotic has come to denote a broader range of...
s (Nitrofurantoin
Nitrofurantoin
Nitrofurantoin is an antibiotic which is marketed under the following brand names; Furadantin, Macrobid, Macrodantin, Nitrofur Mac, Nitro Macro, Nifty-SR, Martifur-MR, Martifur-100 , Urantoin, and Uvamin . It is usually used in treating urinary tract infection...
, trimethoprim
Trimethoprim
Trimethoprim is a bacteriostatic antibiotic mainly used in the prophylaxis and treatment of urinary tract infections.It belongs to the class of chemotherapeutic agents known as dihydrofolate reductase inhibitors...
, cotrimoxazole, cefalexin
Cefalexin
Cefalexin or more commonly cephalexin is a first-generation cephalosporin antibiotic introduced in 1967 by Eli Lilly and Company. It is an orally administered agent with a similar antimicrobial spectrum to the intravenous agents cefalotin and cefazolin...
in those with CRF). Hypertension should be managed with ACE inhibitor
ACE inhibitor
ACE inhibitors or angiotensin-converting enzyme inhibitors are a group of drugs used primarily for the treatment of hypertension and congestive heart failure...
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.