Highlights Glomerular Involvement Secondary to Vesico-Ureteral Reflux (VUR)
Two girls, 15 and 13 years old respectively, with long-standing VUR ended in chronic renal failure. The first case was diagnosed to have bilateral grade III VUR at the age of 5 years. Reimplantation of the ureters was done twice with unsuccessful results. Mild reduction of GFR, inability to concentrate the urine, normal blood pressure and proteinuria below 0.5 g/liter were stable until the age of 9 years when the patient suddenly deteriorated. Severe hypertension developed and proteinuria increased tenfold. She started on dialysis and after bilateral nephrectomy, she was transplanted with a related donor kidney. She is doing well 5 years after transplantation. Her excised kidneys showed severe tubulointerstitial nephritis as well as “crescentic” glomerulonephritis. Ig antibodies and complement in granular pattern were detected in the tubular walls and in the glomerular capillaries. These findings explain the abrupt development of a rapidly progressive glomerulonephritis superimposed on a reflux nephropathy resulting after long-standing VUR.