genitourinary disorders
Vesicoureteral Reflux and Reflux Nephropathy
Introduction
Reflux nephropathy is renal scarring presumably induced by vesicoureteral reflux of infected urine into the renal parenchyma. The diagnosis is suspected in children with urinary tract infections or a family history of reflux nephropathy, or if a prenatal ultrasound shows hydronephrosis. Diagnosis is by voiding cystourethrography or radionuclide cystography. Children with moderate or severe reflux are treated with prophylactic antibiotics or surgical correction. (See also Overview of Tubulointerstitial Diseases and Reflux nephropathy involves a type of chronic tubulointerstitial nephritis as well as glomerular-mediated injury. Traditionally, the mechanism of renal scarring has been thought to be Chronic Pyelonephritis . However, reflux is probably the single most important factor, and factors unrelated to reflux or pyelonephritis (eg, congenital factors) can contribute. Vesicoureteral Reflux (VUR) (VUR) affects about 1% of neonates and 30 to 45% of young children with a febrile Reflux requires incompetent ureterovesical valves or mechanical obstruction in the lower urinary tract. Young children with shorter intravesical portions of the ureter are most susceptible; normal growth usually results in spontaneous cessation of intrarenal and vesicoureteral reflux by age 5. New scars in children>5 years are unusual but may occur after acute pyelonephritis. 