Reflux Nephropathy
Last reviewed: 23.04.2024
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One of the severe conditions that form 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 tubulo-interstitial nephritis associated with reflux. At present, it should be assumed that the development of fibrotic, dysplastic and inflammatory lesions of the renal parenchyma in children with vesicoureteral reflux is not a complication, but a partial manifestation of this condition.
[Causes of reflux nephropathy in children
Currently, there are four possible mechanisms for the development of focal nephrosclerosis: the collaptoid lesion of the parenchyma (ischemia); autoimmune lesion of kidney tissue; humoral theory of reflux-nephropathy; immune renal damage.
The question of the role of urinary system infection (IMI) in the formation of reflux-nephropathy continues to be debated. However, the diagnosis of reflux-nephropathy, before the debut of the urinary tract infection, indicates the possibility of the formation of reflux-nephropathy under the influence of sterile vesicoureteral reflux, even in the antenatal and neonatal period. The main reason for the assumption of the leading role of the infectious process in the formation of sclerosis of kidney tissue is that the cause for nephro-urological examination of patients is very often the infection of the urinary tract and the attack of pyelonephritis.
Symptoms of reflux nephropathy in children
The clinical manifestations of reflux-nephropathy depend on the infection of the reflux. With sterile vesicoureteral reflux, the formation of nephrosclerosis proceeds asymptomatically or is accompanied by signs characteristic of vesicoureteral reflux. Proteinuria and leicocyturia appear only with significant disturbances in the structure of the kidney tissue.
With infected vesicoureteral reflux, there are signs of infection of the urinary system: intoxication, pain syndrome, urinary syndrome (leicocyturia, mild proteinuria).
Diagnosis of reflux-nephropathy in children
On the ultrasound picture of the kidneys in the presence of reflux-nephropathy there is a decrease in the size of the kidneys, a lag in their growth in dynamics, uneven knobby contours, poorly differentiated unevenly expressed with hyperechogenic parenchyma patches, an expansion of the pelvic echo signal.
When performing dopplerography of the kidneys, one can observe a decrease in blood flow against the background of a decrease in the resistance index.
According to ultrasound and dopplerography, three groups of children are identified. The first group includes children with ultrasound signs of the Rn. Lag of kidney size, decreased renal blood flow, a decrease or increase in the index of vascular resistance. In the second - children with a "small kidney", when against the backdrop of the size of the kidneys there is no change in renal hemodynamics (it is possible that in these cases the vesicoureteral reflux develops already into the hypoplastic kidney). In the third - children at the stage of "pre-reflux-nephropathy", when against the background of a small lag in the size of the kidneys there is a change in the resistance of renal vessels.
What do need to examine?
Treatment of vesicoureteral reflux and reflux nephropathy in children
When choosing a treatment plan for vesicoureteral reflux and its complications, a thinly differentiated approach is necessary, since surgical intervention on a relatively immature vesicoureteral segment can interrupt the natural maturation process and affect the functions of the organs of the vascular system in the future. In addition, differential diagnosis of the causes of reflux (developmental defect, morpho-functional immaturity or inflammation) is difficult, which is especially characteristic for children under three years old.
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