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Reflux nephropathy and hypertension
1Institute of Child Health and Great Ormond Street Children's Hospital NHS Trust, London, UK.
Insights
Children with kidney scarring from vesico-ureteric reflux (VUR) face a high risk of developing hypertension later in life. Early identification and prevention strategies are crucial but challenging.
Area of Science:
- Pediatric Nephrology
- Hypertension Research
- Genetics of Renal Disease
Background:
- Vesico-ureteric reflux (VUR) in children can lead to renal scarring, a known risk factor for developing hypertension later in life.
- Hypertension associated with reflux nephropathy significantly contributes to patient morbidity and renal function decline.
- The precise mechanisms underlying hypertension onset in reflux nephropathy remain unclear, though renin-angiotensin system and sodium/potassium ATPase abnormalities are implicated.
Purpose of the Study:
- To investigate the link between renal scarring from VUR and the risk of developing hypertension.
- To explore potential mechanisms contributing to hypertension in reflux nephropathy.
- To assess current strategies for preventing renal scarring and hypertension in affected children.
Main Methods:
- Review of existing literature on VUR, renal scarring, and hypertension.
- Analysis of potential pathophysiological mechanisms, including hormonal and enzymatic pathways.
- Evaluation of the effectiveness of preventative measures and genetic factors.
Main Results:
- Radiologically detected renal scars or small kidneys may represent diverse underlying pathologies.
- Predicting individual hypertension risk is difficult, necessitating regular patient follow-up.
- Preventing renal scar development in children with VUR may reduce hypertension incidence, but effective universal strategies are lacking, especially before infections occur.
Conclusions:
- Primary VUR appears to be an autosomal dominant disorder, offering potential for early genetic identification within families.
- Timely implementation of preventative measures could be possible with early identification, despite current uncertainties about their efficacy.
- Regular monitoring remains essential for managing hypertension risk in individuals with a history of VUR and renal scarring.
Abstract:
Renal scarring associated with vesico-ureteric reflux (VUR), most commonly detected in young children, is associated with a significant risk of developing hypertension in later life. Hypertension in reflux nephropathy contributes significantly to morbidity including deterioration of renal function. The mechanism of onset of hypertension is not clear although abnormalities of the renin-angiotensin system and sodium/potassium ATPase activity have been described in some cases. It is becoming clear that radiologically detectable renal scars or small kidneys may histologically indicate a variety of diagnoses. Prediction of the risk of developing hypertension in individual cases is difficult and therefore regular follow-up remains the only current means of recognising these subjects. Although prevention of renal scar development in children with VUR may offer some benefit in reducing the incidence of hypertension, there is no uniform action that can definitely achieve this, particularly in the very young, before any urinary infection occurs. Primary VUR seems to be a disorder with mendelian dominant inheritance and location of the gene may offer some hope of early identification within certain families. Timely introduction of preventative measures may then be possible even though reservations exist about their effectiveness.