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Published on: July 3, 2013
Vesicoureteral reflux, reflux nephropathy, and end-stage renal disease
1Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, CA 94143-0532, USA. brakemanp@peds.ucsf.edu
Insights
Vesicoureteral reflux (VUR) rarely leads to end-stage renal disease (ESRD), but identifying at-risk pediatric patients is crucial. Early detection and intervention can prevent further kidney damage and preserve function.
Area of Science:
- Nephrology
- Pediatric Urology
Background:
- Vesicoureteral reflux (VUR) is a common condition in children.
- VUR can lead to reflux nephropathy (RN), chronic kidney disease (CKD), and infrequently end-stage renal disease (ESRD).
Purpose of the Study:
- To review the role of VUR and RN in the development of ESRD.
- To identify risk factors for CKD and ESRD progression in patients with VUR.
Main Methods:
- Review of published research articles.
- Analysis of publicly available patient registries.
Main Results:
- Progression to ESRD from VUR is rare and typically occurs over decades.
- Risk factors for progression include reduced GFR, bilateral disease, high-grade VUR, proteinuria, and hypertension.
- Limited evidence exists from prospective trials to guide preventative therapy.
Conclusions:
- Clinical, biochemical, and radiological evaluations should aim to identify VUR patients at high risk for CKD and ESRD.
- Treatment strategies must focus on preventing new renal injury and preserving existing kidney function.
Objective:
To review the contribution of vesicoureteral reflux and reflux nephropathy to end-stage renal disease.
Data Source:
Published research articles and publicly available registries.
Results:
Vesicoureteral reflux (VUR) is commonly identified in pediatric patients and can be associated with reflux nephropathy (RN), chronic kidney disease (CKD), and rarely end-stage renal disease (ESRD). Patients with reduced GFR, bilateral disease, grade V VUR, proteinuria, and hypertension are more likely to progress to CKD and ESRD. Because progression to ESRD is rare in VUR and often requires many decades to develop, there are limited prospective, randomized, controlled trials available to direct therapy to prevent progression to ESRD.
Conclusions:
Identification of patients with increased risk of progression to CKD and ESRD should be the goal of clinical, biochemical, and radiological evaluation of patients with VUR. Treatment of patients with VUR should be directed at preventing new renal injury and preserving renal function.
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