Reflux Nephropathy

  • John Hodson


“Reflux Nephropathy” is a term coined to encompass the spectrum of kidney disease forms in which vesico-ureteral reflux plays a major etiologic role; a group that has morbic anatomical changes with varying but distinctive features. Urinary infection and raised pressure within the urinary tract are commonly associated, but the ways in which those three etiologic factors combine to produce the differing disease entities is not yet established. The renal damage tends to commence at a very early age; and its more severe complications, severe hypertension and renal failure, are well documented from as young as five years onwards, the bulk of the clinical impact being between the ages of 10 and 30 years. Because the essence of the disease is severe focal fibrosis which strangles the parenchyma it enmeshes and which is largely unaffected by treatment once it has become established, the only hopeful method of approach, as in the case of cystic fibrosis, lies in early diagnosis and prevention rather than later amelioration or cure.


Polar Region Renal Damage Vesicoureteric Reflux Renal Scarring Posterior Urethral Valve 
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  1. 1.
    Acton, C.M. and Drew, J.H.: Vesico-ureteric reflux in the neonatal Period. In Hodson, C.J. and Kincaid-Smith, P. (eds.): Reflux Nephropathy. New York: Masson Publishing, U.S.A., Inc., 1979, chap. 7.Google Scholar
  2. 2.
    Allan, T.: Urodynamic patterns in children with dysfunctional voiding problems. J. Urol. 117: 247–249, 1978.Google Scholar
  3. 3.
    Allen, T.D.: Vesicoureteral reflux as a manifestation of dysfunctional Voiding. In Hodson, C.J. and Kincaid-Smith, P. (eds.): Reflux Nephropathy. New York: Masson Publishing, U.S.A., Inc., 1979, chap. 18.Google Scholar
  4. 4.
    Amar, A.D.: Calicotubular backflow with vesico-ureteral reflux. JAMA 213: 293–294, 1970.PubMedCrossRefGoogle Scholar
  5. 5.
    Amar, A.D., Singer, B. and Lewis, R.: Vesico-ureteral reflux in adults. A twelve year study of 122 patients. Urol. 3: 184–189, 1974.PubMedCrossRefGoogle Scholar
  6. 6.
    Aperia, A., Broberger, O., and Ekengren, K.: Correlation between kidney parenchymal area and renal function in vesicoureteral reflux of different degrees. Ann. de Radiol. 12: 141–144, 1977.Google Scholar
  7. 7.
    Arant, B.S., Jr., Sotelo, Avilia C. and Bernstein, J.: Segmental “Hypoplasia” of the Kidney (Ask-Upmark). J. Pediatr. 95: 931–939, 1979.PubMedCrossRefGoogle Scholar
  8. 8.
    Ask-Upmark, E.: Uber juvenile maligne Nephrosklerose und ihr Verhaltnis zu Störungen in der Nierenentwicklung. Acta Pathol. Microbiol. Scand. 6: 383–442, 1929.CrossRefGoogle Scholar
  9. 9.
    Bailey, R.R.: The relationship of vesico-ureteric reflux to urinary tract infection and chronic pyelonephritis — reflux nephropathy. Clin. Nephrol. 1(3): 132–141, 1973.PubMedGoogle Scholar
  10. 10.
    Bauer, S.B., Willscher, M.K., et al.: Long-term Results of Antireflux Surgery in Children. In Hodson, C.J. and Kincaid-Smith, P. (eds.): Reflux Nephropathy. New York: Masson Publishing, U.S.A., Inc., 1979, chap. 29.Google Scholar
  11. 11.
    Benz, G., Willich, E. and Scharer, K.: Segmental renal hypoplasia in childhood. Pediatr. Radiol. 5: 86–92, 1976.PubMedCrossRefGoogle Scholar
  12. 12.
    Breckenridge, A., Preger, L., Dollery, C.T. et al.: Hypertension in the young. Quart. J. Med. 36: 144, October 1967.Google Scholar
  13. 13.
    Dein, R.W., Walker, D. and Hackett, R.L.: The Ask-Upmark kidney. A case report. Arch. Pathol. 96: 10–13, 1973.PubMedGoogle Scholar
  14. 14.
    Dent, C.W. and Hodson, C.J.: Radiological changes associated with certain metabolic bone diseases. Br. J. Radiol. 27: 605–618, 1976.CrossRefGoogle Scholar
  15. 15.
    Drew, J.H. and Acton, C.M.: Radiological findings in newborn infants with urinary infection. Arch. Dis. Child. 51: 628, 1976.PubMedCrossRefGoogle Scholar
  16. 16.
    Dworskin, J.Y.: Sibling uropathology. J. Urol. 115: 726–727, 1976.Google Scholar
  17. 17.
    Fairley, K.F., Becker, G.F., Butler, H.M. et al.: Diagnosis in the difficult case. Kidney Int. 8(Suppl. 4): S12–S19, 1975.Google Scholar
  18. 18.
    Fasth, A., Hanson, L.A. et al, : Autoantibodies to Tamm-Horsfall Protein associated with urinary tract infection in girls. J. Pediatr. 95: 54–60, 1979.PubMedCrossRefGoogle Scholar
  19. 19.
    Fikri, E., Hanrahan, J.B. and Strept, L.A.: Renovascular hypertension in a child: Ask-Upmark Kidney. J. Urol. 110: 728–731, 1973.PubMedGoogle Scholar
  20. 20.
    Filly, R., Friedland, G.N., Govan, D.E. et al.: Urinary tract infections in children. Part II. Roentgenologic aspects. West J. Med. 121: 366–373, 1974.Google Scholar
  21. 21.
    Frey, R.N., Patel, H.R. and Parsons, V.: Familial renal tract abnormalities and cortical scarring. Nephron 12: 188–196, 1974.CrossRefGoogle Scholar
  22. 22.
    Funston, M.: Post-mortem studies of intrarenal reflux in children’s kidneys. Abstract No. S.0094. Book of Abstracts. 6th Int. Congress of Radiol., 1977.Google Scholar
  23. 23.
    Gill, D.G., Mendes da Costa, B., Cameron, J.S. et al.: Analysis of 100 children with severe and persistent hypertension. Arch. Dis. Child. 51: 951–957, 1976.PubMedCrossRefGoogle Scholar
  24. 24.
    Habib, R., Courtecuisse, V., Ehrensperger, J. et al.: Hypoplasie segmentaire du rein avec hypertension arterielle chez l’enfant. Ann. de Pediatr. 12: 262–279, 1965.Google Scholar
  25. 25.
    Helin, I.: Clinical and experimental studies on vesico-ureteric reflux: Thesis. Lund, 1975.Google Scholar
  26. 26.
    Heptinstall, R.H.: The enigma of chronic pyelonephritis. J. Infect. Dis. 120: 104–107, 1969.PubMedCrossRefGoogle Scholar
  27. 27.
    Hodson, C.J., Craven, J.D., Lewis, D.G. et al.: Experimental obstructive nephropathy in the pig. Br. J. Urol., Suppl. 6, 1969.Google Scholar
  28. 28.
    Hodson, C.J., Davies, Z. and Prescod, A.: Renal parenchymal radiographic measurement in infants and children. Pediatr. Radiol. 3: 16–19, 1975.PubMedCrossRefGoogle Scholar
  29. 29.
    Hodson, C.J. and Edwards, D.: Chronic pyelonephritis and vesico-ureter reflux. Clin. Radiol. 11: 219–231, 1960.PubMedCrossRefGoogle Scholar
  30. 30.
    Hodson, C.J., Maling, T.M.J., McManamon, P.J. et al.: The pathogenesis of reflux nephropathy. Br. J. Radiol., Suppl. 13, 1975.Google Scholar
  31. 31.
    Hoyer, J.R.: Autoimmune tubulo-interstitial nephritis induced in rats by immunization with Tamm-Horsfall Urinary Glycoprotein. Kidney Int. 10: 544, 1976.Google Scholar
  32. 32.
    Hoyer, J.R. and Seiler, M.W.: Pathophysiology of Tamm-Horsfall Protein. Kidney Int. 16: 279–289, 1979.PubMedCrossRefGoogle Scholar
  33. 33.
    Hunt, J.S. and McGiven, A.R.: Stimulation of human peripheral blood lymphocytes by Tamm-Horsfall Urinary Protein. Immunol. 35: 391–395, 1978.Google Scholar
  34. 34.
    Hutch, J.A., Hinman, F., Jr., and Miller, E.R.: Reflux as a cause of hydronephrosis and chronic pyelonephritis. J. Urol. 88: 169–175, 1962.PubMedGoogle Scholar
  35. 35.
    Hutch, J.A. and Smith, D.R.: Sterile reflux. Urol. Int. 24: 460–465, 1969.PubMedCrossRefGoogle Scholar
  36. 36.
    Javapour, N., Doppman, J.L., Scardino, P.T. et al.: Segmental renal vein assay and segmental nephrectomy for correction of renal hypertension. J. Urol. 115: 580–582, 1976.Google Scholar
  37. 37.
    Johnston, J.H. and Mix, L.W.: The Ask-Upmark kidney: a form of ascending pyelonephritis? Br. J. Urol. 48: 393–398, 1976.PubMedCrossRefGoogle Scholar
  38. 38.
    Kaufman, J. and Fay, R.: Renal hypertension in children. In Johnston, J.H. and Goodwin, W.E.(eds.): Reviews in Paediatric Urology. Amsterdam, Excerpta Medica 207: 240, 1974.Google Scholar
  39. 39.
    Kimmelstiel, P. and Wilson, C.: Inflammatory lesions in the glomeruli in pyelonephritis in relation to hypertension and renal insufficiency. Am. J. Pathol. 12: 99–105, 1936.PubMedGoogle Scholar
  40. 40.
    Kincaid-Smith, P.: Glomerular lesions in atrophic pyelonephritis and reflux nephropathy. Kidney Int. 8(Suppl. 4): S81–S83, 1975.Google Scholar
  41. 41.
    Kincaid-Smith, P.: Vascular obstruction in chronic pyelonephritis kidneys and its relation to hypertension. Lancet 1: 1263–1269, 1955.CrossRefGoogle Scholar
  42. 42..
    Kincaid-Smith, P. and Hodson, C.J.: In preparation.Google Scholar
  43. 43..
    Klauber, G.T.: Personal communication.Google Scholar
  44. 44.
    Koff, S.A., Lapides, J. and Piazza, D.H.: The uninhibited bladder in children: A cause for urinary obstruction, infection, and reflux. In Hodson, C.J. and Kincaid-Smith, P. (eds.): Reflux Nephropathy. New York: Masson Publishing, U.S.A., Inc., 1979, chap. 17.Google Scholar
  45. 45.
    Kunin, C.M.: Epidemiology and natural history of urinary tract infection in school age children. Pediatr. Clin. N. Am. 8: 509–528, 1971.Google Scholar
  46. 46.
    Lattimer, J.K., Apperson, J.W., Gleason, D.M. et al.: The pressure at which reflux occurs, an important indication of prognosis and treatment. J. Urol. 89: 395–404, 1963.Google Scholar
  47. 47.
    Lewy, P.R. and Belman, A.B.: Familiar occurrence of nonobstructive, noninfectious, vesicoureteral reflux with renal scarring. J. Pediatr. 86: 851–856, 1974.CrossRefGoogle Scholar
  48. 48.
    Ljungquist, A. and Lagergren, C.: The Ask-Upmark kidney. A congenital renal anomaly studied by micro-angiography and histology. Acta Pathol. Microbiol. Scand. 56: 277–283, 1962.CrossRefGoogle Scholar
  49. 49.
    Longcope, W.T. and Winkenwerder, W.L.: Clinical features of the contracted kidney due to pyelonephritis. Bull. Johns Hopkins Hosp. 53: 255–287, 1933.Google Scholar
  50. 50.
    Losse, H., Intorp, H.W., Lison, H.E. et al.: Evidence of an autoimmune mechanism in pyelonephritis. Kidney Int. 8(Suppl. 4): S44–S49, 1975.Google Scholar
  51. 51.
    Lyon, R.P., Marshall, S. and Tanagho, E.A.: The ureteric orifice: Its configuration and competence. J. Urol. 102: 504–509, 1969.PubMedGoogle Scholar
  52. 52.
    Lyon, R.P., Marshall, S. and Tanagho, E.A.: Theory of maturation: A critique. J. Urol. 103: 795–800, 1970.PubMedGoogle Scholar
  53. 53.
    McLachlan, M.S.F., Meiler, S.T., Jones, E.R.V. et al.: Urinary tract infection in school girls with covert bacteriuria. Arch. Dis. Child. 150: 253–258, 1975.CrossRefGoogle Scholar
  54. 54.
    Mathew, T.H., Mathews, D.C., Hobbs, J.B. et al.: Glomerular lesions after renal transplantation. Am. J. Med. 59: 177–190, 1975.PubMedCrossRefGoogle Scholar
  55. 55..
    Mayrer, A.R., Kashgarian, M. et al.: Tubulointersitial nephritis and Tamm-Horsfall Antibody in rabbits challenged with homologous urine. (In press).Google Scholar
  56. 56..
    Mayrer, A.R., Ruddle, N. et al.: Tubulointerstitial nephritis and cell mediated immunity to Tamm-Horsfall Protein in rabbits challenged with homologous urine. (In press).Google Scholar
  57. 57.
    Meadow, S.R., White, R.H.R. and Johnston, N.M.: Prevalence of symptomless urinary tract disease in Birmingham schoolchildren. Br. Med. J. 3: 81, 1969.PubMedCrossRefGoogle Scholar
  58. 58.
    Miller, H.C. and Caspari, E.W.: Ureteral reflux as a genetic trait. JAMA 220: 842–846, 1972.PubMedCrossRefGoogle Scholar
  59. 59.
    Perale, R., Passerin, G. and Rizzoni, G.: Correlations between radiological and endoscopic findings in reflux nephropathy. Am. Radiol. 21: 241–247, 1978.Google Scholar
  60. 60..
    Proceedings of the European Dialysis and Transplant Association, 1976.Google Scholar
  61. 61.
    Randolph, M.F., Morris, K.E. and Gould, E.G.: The first urinary tract infection in the female infant. Prevalence, recurrence, and prognosis: a 10-year study in private practice. J. Pediatr. 86: 342–348, 1975.PubMedCrossRefGoogle Scholar
  62. 62.
    Ransley, P.G. and Risdon, R.A.: Renal papillary morphology and intrarenal reflux in the young pig. Urol. Res. 3: 105–109, 1975.PubMedGoogle Scholar
  63. 63.
    Ransley, P.G. and Risdon, R.A.: Renal papillary morphology in infants and young children. Urol. Res. 3: 110–113, 1975.Google Scholar
  64. 64.
    Rolleston, G.L., Maling, T.M.J, and Hodson, J.: Intrarenal reflux and the scarred kidney. Arch. Dis. Child. 49: 531–539, 1974.PubMedCrossRefGoogle Scholar
  65. 65.
    Rolleston, G.L., Shannon, F.T. and Utley, W.L.F.: Relationship of infantile vesicouretic reflux and renal damage. Br. Med. J. 21: 460–463, 1970.CrossRefGoogle Scholar
  66. 66.
    Roper, B.A. and Smith, J.C.: Vesico-ureteric reflux following operations on the ureteric orifice. Br. J. Urol. 37: 531–534, 1965.PubMedCrossRefGoogle Scholar
  67. 67.
    Rosenfield, J.F., Cohen, L., Garity, L. et al.: Unilateral renal hypoplasia with hypertension. (Ask-Upmark Kidney). Br. Med. J. 2: 217–218, 1973.CrossRefGoogle Scholar
  68. 68.
    Savage, D.C.L., Wilson, M.I., McHardy, M. et al.: Covert bac-teriuria in childhood. A clinical and epidemiological study. Arch. Dis. Child. 43: 8–20, 1973.CrossRefGoogle Scholar
  69. 69.
    Scott, J.E.S. and Stansfeld, J.M.: Ureteric reflux and scarring in children. Arch. Dis. Child. 43: 468–470, 1968.PubMedCrossRefGoogle Scholar
  70. 70.
    Selkon, J. et al.: Asymptomatic bacteriuria in school children in Newcastle-upon-Tyne. Newcastle Asymptomatic Bacteriuria Research Group. Arch. Dis. Child. 50: 2, 1975.Google Scholar
  71. 71.
    Shah, K.J., Robins, D.G. and White, R.H.R.: Renal scarring and vesico-ureteric reflux. Arch. Dis. Child. 53: 210–218, 1978.PubMedCrossRefGoogle Scholar
  72. 72.
    Siegler, R.N.: Malignant hypertension in children with chronic pyelonephritis. Laboratory and radiologic indications for partial or total nephrectomy. Urol. 7: 474–477, 1976.PubMedCrossRefGoogle Scholar
  73. 73.
    Smellie, M., Edwards, D., Hunter, N. et al.: Vesico-ureteric reflux and renal scarring. Kidney Int. 8(Suppl. 4): S65–S72, 1975.Google Scholar
  74. 74.
    Staemmler, M. and Dopheide, W.: Virch. Arch. Path. Ant. Physiol. 277: 713–756, 1930.CrossRefGoogle Scholar
  75. 75.
    Tamminen, T.E. and Kapiro, E.A.: The relation of the shape of renal papillae and of collecting duct openings to intrarenal reflux. Br. J. Urol. 49: 345–353, 1977.PubMedCrossRefGoogle Scholar
  76. 76.
    Tanagho, E.A., Miller, E.R., Lyon, R.P. et al.: Spastic external sphincter and urinary tract infection in girls. Br. J. Urol. 43: 69–82, 1971.PubMedCrossRefGoogle Scholar
  77. 77.
    Teague, N. and Boyarsky, S.: Further effects of coliform bacteria on ureteral peristalsis. J. Urol. 99: 720–726, 1968.PubMedGoogle Scholar
  78. 78..
    Van Gool, J.D.: Bladder infection and pressure. In Hodson, C.J. and Kincaid-Smith, P. (eds.): Relux Nephropathy. New York: Masson Publishing, U.S.A., Inc., 1979, chap. 19.Google Scholar
  79. 79.
    Vermillion, C.D. and Heale, W.F.: Position and configuration of the ureteral orifice and its relationship to renal scarring in adults. J. Urol., 1973.Google Scholar
  80. 80..
    Wagner, E.L.: Handbuch der Krankheiten des Harnapparates. I. Der Morbus Bright. In. von Ziemssen, H.W.: Handbuch der speziellen Pathologie und Therapie. 9: 309–315 (Vogel, Leipzig, 1882).Google Scholar
  81. 81.
    Weiss, S. and Parker, F., Jr.: Pyelonephritis: Its relation to vascular lesions and to arterial hypertension. Medicine 18: 221–315, 1939.CrossRefGoogle Scholar
  82. 82.
    Williams, D.I.: Urology in Childhood. New York: Springer, 1974, p. 135.Google Scholar
  83. 83.
    Williams, D.I.: Paediatric Urology. London: Butterworths, 1968, pp. 181–182.Google Scholar
  84. 84.
    Winberg, J., Andersen, H.J., Bergstrom, T. et al.: Epidemiology of symptomatic infection in childhood. Acta Paediatr. Scand. Suppl. 252, 1974.Google Scholar
  85. 85..
    Winberg, J., Claesson, I. et al.: Renal growth after acute pyelonephritis in childhood: An epidemiological approach. In Hodson, C.J. and Kincaid-Smith, P. (eds.): Reflux Nephropathy. New York: Masson Publishing, U.S.A., Inc., 1979, chap. 20.Google Scholar
  86. 86.
    Zel, F. and Retik, A.B.: Familial vesico-ureteral reflux. Urology 2: 249–252, 1973.PubMedCrossRefGoogle Scholar
  87. 87.
    Zimmerman, S.W., Uehling, D.T. and Burkholder, P.M.: Vesicoureteral reflux nephropathy. Evidence for immunologically mediated nephropathy. Urology 11: 534–538, 1973.CrossRefGoogle Scholar

Copyright information

© Plenum Press, New York 1981

Authors and Affiliations

  • John Hodson
    • 1
  1. 1.Diagnostic Radiol.Yale Univ. School of Medicine and Yale New Haven HospitalNew HavenUSA

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