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Reflux nephropathy
Last reviewed: 12.07.2025
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One of the severe conditions that develops against the background of vesicoureteral reflux is reflux nephropathy.
Reflux nephropathy in children is a disease that occurs against the background of vesicoureteral reflux, characterized by the formation of focal or generalized sclerosis in the renal parenchyma.
According to ICD-10, this condition belongs to the group of tubulointerstitial nephritis associated with reflux. At present, it should be assumed that the development of fibrous, dysplastic and inflammatory lesions of the renal parenchyma in children with vesicoureteral reflux is not a complication, but a particular manifestation of this condition.
[ Causes of Reflux Nephropathy in Children
Currently, four possible mechanisms for the development of focal nephrosclerosis are distinguished: collapse-like damage to the parenchyma (ischemia); autoimmune damage to renal tissue; humoral theory of reflux nephropathy; immune damage to the kidneys.
The role of urinary tract infection (UTI) in the development of reflux nephropathy continues to be debated. However, diagnostics of reflux nephropathy before the onset of urinary tract infection indicates the possibility of developing reflux nephropathy under the influence of sterile vesicoureteral reflux even in the antenatal and neonatal periods. The main reason for the assumption of the leading role of the infectious process in the development of renal tissue sclerosis is that the reason for nephro-urological examination of patients is very often urinary tract infection and an attack of pyelonephritis.
Symptoms of reflux nephropathy in children
Clinical manifestations of reflux nephropathy depend on the infection of the reflux. In sterile vesicoureteral reflux, the formation of nephrosclerosis is asymptomatic or accompanied by signs characteristic of vesicoureteral reflux. Proteinuria and leukocyturia appear only with significant disturbances in the structure of the kidney tissue.
With infected vesicoureteral reflux, signs of urinary tract infection are observed: intoxication, pain syndrome, urinary syndrome (leukocyturia, moderate proteinuria).
Diagnostics of reflux nephropathy in children
In the ultrasound image of the kidneys in the presence of reflux nephropathy, a decrease in the size of the kidneys, a lag in their growth dynamics, uneven lumpy contours, poorly differentiated, unevenly expressed parenchyma with hyperechoic areas, and an expansion of the renal pelvic echo signal are noted.
When performing Doppler ultrasonography of the kidneys, a decrease in blood flow can be observed against the background of a decrease in the resistance index.
According to the ultrasound and Doppler examination, three groups of children are distinguished. The first group includes children with ultrasound signs of Rn. lag in kidney size, decreased renal blood flow, decrease or increase in the vascular resistance index. The second group includes children with a "small kidney", when, against the background of lag in kidney size, no change in renal hemodynamics is observed (it is possible that in these cases vesicoureteral reflux develops into a hypoplastic kidney). The third group includes children at the stage of "prereflux nephropathy", when, against the background of a slight lag in kidney size, a change in the resistance of the renal vessels is observed.
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Treatment of vesicoureteral reflux and reflux nephropathy in children
When choosing a treatment plan for vesicoureteral reflux and its complications, a finely differentiated approach is necessary, because surgical intervention on a relatively immature vesicoureteral segment can interrupt the natural maturation process and affect the function of the urinary system organs in the future. In addition, differential diagnostics of the causes of reflux (developmental defect, morpho-functional immaturity or inflammation) is difficult, which is especially typical for children under three years of age.
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