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End-stage reflux nephropathy
R R Bailey1, K L Lynn, R A Robson
1Department of Nephrology, Christchurch Hospital, New Zealand.
Insights
Reflux nephropathy is a significant cause of end-stage renal failure, especially in young individuals. Early exclusion is crucial for patients with renal insufficiency, proteinuria, or hypertension, even without urinary tract infections.
Area of Science:
- Nephrology
- Urology
- Transplantation
Background:
- Reflux nephropathy is a recognized cause of end-stage renal disease (ESRD).
- Its prevalence and clinical presentation in patients entering dialysis-transplant programs require further elucidation.
- Understanding risk factors and diagnostic indicators is vital for timely intervention.
Purpose of the Study:
- To determine the incidence of reflux nephropathy in patients referred for renal replacement therapy.
- To characterize the clinical features and outcomes of patients with end-stage reflux nephropathy.
- To assess the role of urinary tract infections, hypertension, and proteinuria in the presentation of reflux nephropathy.
Main Methods:
- Retrospective analysis of 371 patients entering a dialysis-transplant program.
- Identification of patients diagnosed with reflux nephropathy.
- Review of clinical data including age, renal function, blood pressure, proteinuria, and history of urinary tract infections.
Main Results:
- 11.3% (42/371) of patients had end-stage reflux nephropathy.
- 6 out of 13 pediatric patients (<16 years) had reflux nephropathy.
- Most patients presented with severe renal impairment, hypertension (35/42), and proteinuria; UTIs were infrequent.
- Hypertension was often undiagnosed prior to presentation (22/35).
- 20 out of 29 surviving patients received functioning renal transplants.
Conclusions:
- Reflux nephropathy is a critical contributor to ESRD, particularly in younger populations.
- Patients with renal insufficiency and proteinuria, irrespective of UTI or hypertension, should be evaluated for reflux nephropathy.
- Early diagnosis and management are essential to improve outcomes and transplant success rates.
Abstract:
Forty-two of 371 patients (11.3%) entering a dialysis-transplant program had end-stage reflux nephropathy. Thirteen of these 371 patients were under 16 years of age, with 6 of them having reflux nephropathy. Most patients presented with severely impaired renal function, hypertension, and proteinuria. Documented urinary tract infections occurred in only 4 of the 18 male and 14 of the 24 female patients. Thirty-five patients had hypertension, which in 22 had not been detected before presentation. Five presented with accelerated hypertension. Eight of the 24 women presented during a pregnancy. Twenty-nine patients are still alive, 20 with a functioning renal transplant. Reflux nephropathy is an important cause of end-stage renal failure, particularly in younger people. All patients presenting with renal insufficiency and proteinuria, with or without urinary tract infections or hypertension, should have reflux nephropathy excluded.