Reflux nephropathy

Reflux Nephropathy, RN is a term applied when small and scarred kidneys ( chronic pyleonephritis, CPN)are associated with vesico-ureteric reflux(VUR).CPN being the commonest 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.It is diagonised by miturating cystography, scarring can ofcourse be demonstrated by ultrasound or DMSA. There is genetic predisposition, first-degree relatives have greatly increased the chance of VUR. The gene frequency is estimated to be 1:600. All children with UTI should be investigated for VUR. The aim of treatment is to reduce renal scarring. Those children with grade II or worse should receive low dose of prophylactic antibiotics(Nitrofurantoin, trimethoprim, cotrimoxazole, cefalexin in those with CRF). Hypertension should be managed with ACE or ARB'S. Other treatment modalities also include surgery ( enodoscopic injection of collagen behind the intra-vesical ureter, uretreic re-implantaion or lengthening of the submucosal ureteric tunnel)which has it's protagonists.