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Intrarenal reflux is linked to subsequent kidney scarring: a retrospective study

Jisun Hwang1, Su Jin Lee2, Ki Soo Pai3,4

  • 1Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea.

Pediatric Nephrology (Berlin, Germany)
|May 24, 2025
PubMed

Insights

Intrarenal reflux, a type of pyelotubular backflow, significantly increases kidney scarring risk in children with urinary tract infections (UTI). This finding aids in tailored management for children with UTI and vesicoureteral reflux (VUR).

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Diagnostic Imaging

Background:

  • Urinary tract infections (UTI) in children can lead to kidney scarring.
  • Intrarenal reflux (pyelotubular backflow) is a specific pattern of urine backflow into the kidney.
  • The association between intrarenal reflux and kidney scarring requires further investigation.

Purpose of the Study:

  • To determine if intrarenal reflux is associated with kidney scarring in children diagnosed with UTI.
  • To evaluate intrarenal reflux as an independent predictor of renal scarring.

Main Methods:

  • Retrospective review of 441 children with UTI who underwent voiding cystourethrography (VCUG) and technetium-99m dimercaptosuccinic acid (DMSA) scans.
  • Intrarenal reflux identified on VCUG; kidney scarring assessed via DMSA scans.
  • Multivariable logistic regression analysis adjusted for vesicoureteral reflux (VUR) grade and clinical variables.

Main Results:

  • Intrarenal reflux was present in 13.7% of kidney units with VUR.
  • Intrarenal reflux was significantly associated with an increased risk of kidney scarring (OR 3.35).
  • 92% of DMSA scan defects in units with intrarenal reflux localized to the reflux site.

Conclusions:

  • Intrarenal reflux is an independent predictor of kidney scarring in children with UTI, beyond standard VUR grading.
  • Identifying intrarenal reflux during VUR assessment is crucial.
  • This finding supports the development of individualized management strategies for pediatric UTI and VUR.
Abstract

Keywords:
Intrarenal refluxKidney scarUrinary tract infectionVesicoureteral reflux

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