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Vesico-ureteric reflux: occurrence and long-term risks
S H Jacobson1, S Hansson, B Jakobsson
1Department of Nephrology, Karolinska Hospital, Stockholm, Sweden.
Insights
Vesico-ureteric reflux (VUR) is more common in specific groups and can lead to kidney scarring, hypertension, and renal failure. Early detection and treatment in children can improve long-term outcomes.
Area of Science:
- Pediatric Nephrology
- Urology
- Internal Medicine
Background:
- Vesico-ureteric reflux (VUR) prevalence in the general population is unknown.
- VUR is elevated in specific risk groups, including children with urinary tract infections (UTIs), asymptomatic bacteriuria in schoolgirls, first-degree relatives of VUR patients, and children with prenatal upper urinary tract dilatation.
- Pyelonephritic renal scarring in children and adults poses risks for severe long-term complications like hypertension and renal failure.
Purpose of the Study:
- To highlight the significance of early detection and treatment of UTIs and VUR in pediatric populations.
- To discuss the long-term complications associated with pyelonephritic renal scarring.
- To explore management strategies for adult patients with established renal scarring.
Main Methods:
- Review of existing literature on vesico-ureteric reflux and pyelonephritis.
- Analysis of risk factors associated with VUR.
- Discussion of current and potential treatment modalities for VUR and its sequelae.
Main Results:
- VUR is more prevalent in identified pediatric risk groups.
- Pyelonephritic renal scarring is linked to serious long-term health issues, including hypertension and renal failure.
- Early intervention in childhood and adolescence may enhance long-term prognosis.
Conclusions:
- Prompt diagnosis and management of UTIs and VUR in children are crucial for improving long-term renal health.
- In adults with established pyelonephritic renal scarring, hypertension management is vital.
- Angiotensin-converting enzyme inhibitors may offer renal protection in adult patients with established scarring.
Abstract:
The prevalence of vesico-ureteric reflux in the general population is unknown, but it is increased in risk groups, such as children with symptomatic urinary tract infection, schoolgirls with asymptomatic bacteriuria, first-degree relatives of patients with reflux and children with prenatal dilatation of their upper urinary tract. Children and adults with pyelonephritic renal scarring are at risk of serious long-term complications, e.g. hypertension and renal failure. Modern paediatric care, with early detection and treatment of urinary tract infections and reflux during childhood and adolescence, may improve long-term prognosis. In the adult patient with established pyelonephritic renal scarring, careful control of hypertension may retard the rate of progression, and angiotensin converting enzyme inhibitors may have renal protective properties.