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Reflux nephropathy secondary to intrauterine vesicoureteric reflux
A Najmaldin1, D M Burge, J D Atwell
1Wessex Regional Centre for Paediatric Surgery, Southampton, England.
Insights
Fetal vesicoureteric reflux (VUR) is linked to kidney damage in infants. This study suggests fetal VUR may cause atrophic pyelonephritis, also known as fetal reflux nephropathy, in newborns.
Area of Science:
- Pediatric Nephrology
- Urology
- Fetal Medicine
Background:
- Urinary tract anomalies are frequently diagnosed antenatally.
- Vesicoureteric reflux (VUR) is a significant anomaly, often associated with renal damage.
- The etiology of atrophic pyelonephritis in infants remains under investigation.
Purpose of the Study:
- To investigate the association between antenatally diagnosed VUR and the development of atrophic pyelonephritis in infants.
- To explore the potential role of fetal VUR in causing renal scarring (fetal reflux nephropathy).
Main Methods:
- Retrospective analysis of 107 infants with 182 antenatally diagnosed urinary tract anomalies.
- Evaluation of VUR incidence, severity, and gender distribution.
- Diagnostic imaging including intravenous pyelography (IVP) and isotopic renography to assess renal changes and function.
Main Results:
- 24 infants (22.4%) had VUR, predominantly in boys (16:8 ratio) and severe grades (IV and III).
- IVP revealed atrophic pyelonephritis in 10 refluxing units; 2 also had pelviureteric junctional hydronephrosis.
- Renography showed reduced renal function (9-41%) in 9 of 14 patients; renal changes appeared primary, not infection-related.
Conclusions:
- Findings support the hypothesis that fetal VUR contributes to atrophic pyelonephritis (fetal reflux nephropathy).
- Early diagnosis and management of VUR are crucial to prevent renal scarring and preserve kidney function in infants.
Abstract:
In 107 infants with 182 antenatally diagnosed urinary tract anomalies, 24 had either unilateral (12) or bilateral (12) vesicoureteric reflux (VUR). The VUR was more common in boys (male to female ratio, 16:8) and usually severe (grades IV [16], III [10], II [4], and I [6]). Intravenous pyelography showed the changes of atrophic pyelonephritis in 10 refluxing units, and in another two with an associated pelviureteric junctional hydronephrosis. Lateral ectopia of the ureteric orifices was noted in six of these 10 refluxing renal units. Isotopic renography showed a reduction in function in nine of the 14 patients examined, ranging between 9% and 41%. (45% and above was considered within the normal range). Only two patients developed a urinary infection before intravenous pyelography or isotopic renography was performed, suggesting that renal changes noted were primary rather than secondary. Findings support the hypothesis that foetal VUR may be a contributing factor in the causation of atrophic pyelonephritis (foetal reflux nephropathy) observed in these patients.