skip to content

Reflux nephropathy and chronic pyelonephritis

Educational resources for renal medicine

Licensed under a Creative Commons LicenseCreative Commons Attribution 4.0 International License.


Reflux nephropathy and chronic pyelonephritis

This is a chronic interstitial nephritis associated with vesico-ureteric reflux (VUR, usually congenital) in early life.  There is also a close association with recurrent urinary tract infections , and sometimes there are other urinary tract or other congenital abnormalities such as incomplete growth of the kidney - renal hypoplasia


Pathogenesis

Normally the oblique entrance of the ureter through the bladder wall causes ureteric occlusion during bladder contraction. In VUR there is a structural abnormality of the intra-mural ureter allowing reflux of urine from the bladder to the kidney.  Chronic Interstitial Nephritis becomes established leading to further renal deterioration.  By an uncertain mechanism, interstitial nephritis may cause focal scars and initiate a slowly progressive renal deterioration. 


Clinical features

Often asymptomatic. May present with hypertension, proteinuria reflecting renal damage; or with associated UTIs.  Reflux itself sometimes causes loin pain during micturition but this is rarely a significant problem.


Investigation

Diagnosis is confirmed by demonstration of focal renal scars (cross-sectional imaging or isotope renogram; ultrasound less reliable for this); will also reveal other abnormalities, e.g. obstruction. Urine culture necessary to show infection. Assess renal function, proteinuria etc. in usual way.


Management

Associated UTIs should be managed in the usual way. Correct obstruction.  There is no consistent benefit from procedures to correct reflux. If there is significant renal damage (proteinuria, hypertension, renal function), aggressive control of blood pressure is important.  Other aspects as for CRF of other causes. 


Further info

Proteinuria <<  |  Textbook  |  >> Renal artery

 
Page last modified 01.12.2016, 22:31 by Administrator. edrep and edren are produced by the Renal Unit at the Royal Infirmary of Edinburgh and Univ. Edinburgh. CAUTIONS and Contact us. Note that the information published here is primarily intended for education, not for clinical care.