Reflux Nephropathy

Reflux nephropathy is kidney scarring caused by urine flowing backwards from the bladder towards the kidneys, usually along with repeated kidney infections. It often begins in childhood but may be discovered only in adulthood through high blood pressure, protein in the urine or reduced kidney function. Long-term follow-up can help protect the remaining kidney function.

What Is Reflux Nephropathy?

Normally urine flows in one direction, from the kidneys through the ureters into the bladder. A valve-like mechanism at the bladder prevents it from flowing back. In vesicoureteral reflux (VUR), this mechanism does not work properly, and urine can travel back up towards the kidney.

When reflux is combined with urinary infections, bacteria can reach the kidney and cause inflammation. Repeated episodes may leave scars, and this scarring is called reflux nephropathy.

Causes and Risk Factors

Reflux is often present from birth and may run in families.

• Primary vesicoureteral reflux present from birth
• Recurrent urinary tract infections in childhood, particularly with fever
• Family history of reflux, as brothers, sisters and children of affected people may be at higher risk
• Bladder problems such as poor emptying or high bladder pressure
• Blockage in the lower urinary tract

Symptoms

Reflux itself does not cause pain in most people. Signs usually relate to infections or to the effects of kidney scarring.

• Repeated urinary infections with fever, especially in children
• Burning urine, frequent urination or back pain
• High blood pressure at a young age
• Protein in the urine, sometimes making it frothy
• Reduced kidney function found on blood tests
• Complications during pregnancy in women with known scarring

Diagnosis

Diagnosis may involve an ultrasound of the kidneys and bladder, a special X-ray test called a micturating cystourethrogram (MCU) to show reflux, and a DMSA nuclear scan to detect scarring. Blood and urine tests assess kidney function and protein leakage, and regular blood pressure checks are important.

Treatment

In adults, scarring cannot be reversed, so the focus is on preventing further damage. Children are managed together with a paediatric urologist or paediatric nephrologist.

Adults with reflux nephropathy are usually advised to have regular reviews, often once or twice a year depending on kidney function. These visits typically include a blood pressure check, a urine test for protein and blood tests for creatinine. Maintaining a healthy weight, limiting salt, avoiding smoking and not using painkillers that can harm the kidneys without medical advice may all help protect kidney health over the long term.

• Prompt treatment of urinary infections, and preventive antibiotics in selected cases
• Good bladder and bowel habits, especially in children
• Controlling blood pressure, often with medicines that also reduce protein leakage
• Regular monitoring of kidney function and urine protein
• Surgical or endoscopic correction of reflux in selected patients, done by the urology team
• Planning and close monitoring during pregnancy
• Management of chronic kidney disease if function declines

When to See a Nephrologist

See a nephrologist if you have a history of childhood urinary infections or known reflux and now have high blood pressure, protein in the urine or a raised creatinine. Women with reflux nephropathy who are planning a pregnancy should also seek advice beforehand.

This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.