Learn About Reflux Nephropathy

What is the definition of Reflux Nephropathy?

Reflux nephropathy is a condition in which the kidneys are damaged by the backward flow of urine into the kidney.

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What are the alternative names for Reflux Nephropathy?

Chronic atrophic pyelonephritis; Vesicoureteric reflux; Nephropathy - reflux; Ureteral reflux

What are the causes of Reflux Nephropathy?

Urine flows from each kidney through tubes called ureters and into the bladder. When the bladder is full, it squeezes and sends the urine out through the urethra. No urine should flow back into the ureter when the bladder is squeezing. Each ureter has a one-way valve where it enters the bladder that prevents urine from flowing back up the ureter.

But in some people, urine flows back up to the kidney. This is called vesicoureteral reflux.

Over time, the kidneys may be damaged or scarred by this reflux. This is called reflux nephropathy.

Reflux can occur in people whose ureters do not attach properly to the bladder or whose valves do not work well. Children may be born with this problem or may have other birth defects of the urinary system that cause reflux nephropathy.

Reflux nephropathy can occur with other conditions that lead to a blockage of urine flow, including:

  • Bladder outlet obstruction, such as an enlarged prostate in men
  • Bladder stones
  • Neurogenic bladder, which can occur in people with multiple sclerosis, spinal cord injury, diabetes, or other nervous system (neurological) conditions

Reflux nephropathy can also occur from swelling of the ureters after a kidney transplant or from injury to the ureter.

Risk factors for reflux nephropathy include:

  • Abnormalities of the urinary tract
  • Personal or family history of vesicoureteral reflux
  • Repeat urinary tract infections
What are the symptoms of Reflux Nephropathy?

Some people have no symptoms of reflux nephropathy. The problem may be found when kidney tests are done for other reasons.

If symptoms do occur, they might be similar to those of:

  • Chronic kidney failure
  • Nephrotic syndrome
  • Urinary tract infection
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What are the current treatments for Reflux Nephropathy?

Vesicoureteral reflux is separated into five different grades. Simple or mild reflux often falls into grade I or II. The severity of the reflux and amount of damage to the kidney help determine treatment.

Simple, uncomplicated vesicoureteral reflux (called primary reflux) can be treated with:

  • Antibiotics taken every day to prevent urinary tract infections
  • Careful monitoring of kidney function
  • Repeated urine cultures
  • Yearly ultrasound of the kidneys

Controlling blood pressure is the most important way to slow kidney damage. The health care provider may prescribe medicines to control high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are often used.

Surgery is usually only used in children who have not responded to medical therapy.

More severe vesicoureteral reflux may need surgery, especially in children who do not respond to medical therapy. Surgery to place the ureter back into the bladder (ureteral reimplantation) can stop reflux nephropathy in some cases.

More severe reflux may need reconstructive surgery. This type of surgery may reduce the number and severity of urinary tract infections.

If needed, people will be treated for chronic kidney disease.

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What is the outlook (prognosis) for Reflux Nephropathy?

Outcome varies, depending on the severity of the reflux. Some people with reflux nephropathy will not lose kidney function over time, even though their kidneys are damaged. However, kidney damage may be permanent. If only one kidney is involved, the other kidney should keep working normally.

Reflux nephropathy may cause kidney failure in children and adults.

What are the possible complications of Reflux Nephropathy?

Complications that may result from this condition or its treatment include:

  • Blockage of the ureter after surgery
  • Chronic kidney disease
  • Chronic or repeat urinary tract infections
  • Chronic kidney failure if both kidneys are involved (can progress to end-stage kidney disease)
  • Kidney infection
  • High blood pressure
  • Nephrotic syndrome
  • Persistent reflux
  • Scarring of the kidneys
When should I contact a medical professional for Reflux Nephropathy?

Call your provider if you:

  • Have symptoms of reflux nephropathy
  • Have other new symptoms
  • Are producing less urine than normal
How do I prevent Reflux Nephropathy?

Quickly treating conditions that cause reflux of urine into the kidney may prevent reflux nephropathy.

Female urinary tract
Male urinary tract
Voiding cystourethrogram
Vesicoureteral reflux
What are the latest Reflux Nephropathy Clinical Trials?
Preliminary Study on the Effect of Blood Purification Therapy With Dual-cannula in Jugular-femoral Venous

Summary: Acute kidney failure (AKI) is one of the most important causes of morbidity and mortality for critical ill patients. The use of blood purification treatment such as renal replacement therapy (CRRT) and plasma exchange has gradually developed into an effective treatment. However, the efficiency of blood purification may be affected by the recirculation of dual-lumen venous catheter for some special...

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Patient-Centred Innovations for Persons With Multimorbidity - Quebec

Summary: The aim of Patient-Centred Innovations for Persons With Multimorbidity (PACE in MM) study is to reorient the health care system from a single disease focus to a multimorbidity focus; centre on not only disease but also the patient in context; and realign the health care system from separate silos to coordinated collaborations in care. PACE in MM will propose multifaceted innovations in Chronic Dis...

What are the Latest Advances for Reflux Nephropathy?
Peritoneal dialysis in children: Infectious and mechanical complications: Experience of a tertiary hospital in Elazığ, Turkey.
Bladder augmentation in exstrophy vesicae: Long-term results of a single experienced center.
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Laparoscopic ureteral reimplantation with a Boari flap for long-segment ureteric avulsion or ureteric strictures: our experience.
Who are the sources who wrote this article ?

Published Date: July 27, 2021
Published By: Walead Latif, MD, Nephrologist and Clinical Associate Professor, Rutgers Medical School, Newark, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

What are the references for this article ?

Alexander T, Licht C, Smoyer WE, Rosenblum ND. Diseases of the kidney and upper urinary tract in children. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 72.

Mathews R, Mattoo TK. Primary vesicoureteral reflux and reflux nephropathy. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 61.