Renal changes in vesicoureteral reflux--human reflux nephropathy

Area of Science:

• Nephrology
• Pediatric Nephrology
• Urology

Background:

• Vesicoureteral reflux (VUR) is a common condition associated with urinary tract infections and potential renal damage.
• The long-term consequences of VUR on kidney morphology, particularly in children, require further investigation.

Purpose of the Study:

• To analyze the morphological changes in nephrectomized kidneys from patients with VUR.
• To understand the relationship between VUR, chronic pyelonephritis, and Ask-Upmark kidney.

Main Methods:

• Examination of 25 nephrectomized kidneys from patients diagnosed with VUR between 1977 and 1985.
• Macroscopic and histological analysis of renal parenchyma, focusing on scarring, dilatation, and signs of pyelonephritis.

Main Results:

• Kidneys were often small with focal scarring and calyceal dilatation.
• Histological findings included active and atrophic chronic pyelonephritis, and extensive segmental scarring characteristic of Ask-Upmark kidney.
• Two cases with posterior urethral valve showed intrauterine damage, while others represented developmental stages of chronic pyelonephritis.

Conclusions:

• Renal changes in reflux nephropathy, while showing characteristic features, lack a uniform pathognomic picture.
• The spectrum of morphological changes is viewed as developmental stages of childhood chronic pyelonephritis, with Ask-Upmark kidney as a potential outcome.
• VUR-associated renal pathology is considered a specific pathogenetically determined form of childhood chronic pyelonephritis, often presenting with urinary tract infections.