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Physiopathology of vesico-ureteral reflux

Salvatore Arena1, Roberta Iacona2, Pietro Impellizzeri3

  • 1Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatric Surgery, University of Messina, 98125, Messina, Italy. salarena@unime.it.

Italian Journal of Pediatrics
|December 1, 2016
PubMed

Insights

Vescico-ureteral reflux (VUR) in children stems from congenital issues at the vesico-ureteral junction (VUJ). Abnormalities in ureteral endings, including muscle structure and Sarcoglycan complex modifications, contribute to VUJ incompetence.

Area of Science:

  • Pediatric Urology
  • Developmental Biology
  • Cellular Biology

Background:

  • Vescico-ureteral reflux (VUR) is a common congenital anomaly in children.
  • It originates from abnormalities at the vesico-ureteral junction (VUJ), likely due to abnormal fetal development.
  • Refluxing ureteral endings exhibit structural and functional deficits.

Purpose of the Study:

  • To investigate the causes of functional alterations in refluxing ureteral ends.
  • To explore the role of Sarcoglycan (SG) complex modifications, Cajal cells, and tunnel length to diameter ratio in VUJ incompetence.

Main Methods:

  • Review of existing literature on VUR pathophysiology.
  • Analysis of structural and functional anomalies in refluxing ureteral endings.
  • Focus on smooth muscle cells, Cajal cells, Connexin 43, and Sarcoglycan expression.

Main Results:

  • Decreased smooth muscle actin, myosin, and desmin content in refluxing ureters.
  • Evidence of muscular atrophy, degeneration, and disorganized fibers.
  • Modified Sarcoglycan (SG) sub-complex configuration, including ε-SG deficiency and α-SG overexpression, is implicated.

Conclusions:

  • Congenital muscular deficiency and altered Sarcoglycan expression are key factors in VUR.
  • The roles of Cajal cells and the ureteral tunnel configuration are critical for VUJ function.
  • These factors contribute to the functional alterations leading to VUJ incompetence.

Keywords:
Active antireflux mechanismInterstitial cells of CajalPassive antireflux mechansimSarcoglycanVesicoureteral reflux

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