A long term follow up of adults with reflux nephropathy

To assess the long term follow up of patients with reflux nephropathy.

Two hundred and ninety-four patients over 15 years of age (females 235; caucasians 288) presented between 3 wk and 72 yr of age (mean 17.3 yr; SD 14.4 yr). One hundred and seventy-six had unilateral reflux nephropathy and 118 had bilateral reflux nephropathy diagnosed on intravenous urography and/or a DMSA scintigraphy.

The majority of patients, particularly women, presented with a urinary tract infection. Twenty-five patients (8.5%) had hypertension at presentation, 15 (5.1%) loin or abdominal pain, 14 (4.8%) proteinuria and six (2%) renal insufficiency. At the last follow up (mean age 34.2yr; SD 13.7yr; range 15-81yr), 113 patients (38%) had hypertension or were on antihypertensive therapy. This was significantly more frequent in those with severe bilateral renal parenchymal scarring. Proteinuria was present in 92 (31%); 40 of these had renal insufficiency. Seventy-one (24%) had a creatinine clearance < 70 mL/min and 43 (15%) a urinary tract infection. Eighteen patients had suffered from a urinary calculus. Proteinuria and renal insufficiency were significantly more frequent in those with severe bilateral reflux nephropathy.

All patients with reflux nephropathy who have proteinuria, hypertension or renal insufficiency should be under regular follow up.