Intrarenal Reflux and Renal Damage

Abstract

The retrograde flow of dye from the calices into the collecting tubules (intrarenal reflux) seen during cystrography in children and its effect on the kidneys were evaluated. A retrospective analysis was made of 175 patients with excretory urograms revealing cortical atrophy. Of these patients 68 per cent had cystograms revealing vesicoureteral reflux. Intrarenal reflux was seen in 8 patients less than 6 years old, an incidence of 13.5 per cent in that age group. There was a high correlation, 7 of 8 or 87.5 per cent, between the areas of intrarenal reflux, and associated renal cortical atrophy and calicectasis. Intrarenal reflux provides a pathway by which bacteria and hydrostatic pressure may produce injury to the renal parenchyma. The presence of intrarenal reflux is an absolute indication for ureteroneocystostomy.

Uretero‐Neo‐Cystostomy in Renal Transplantation. Is An Antireflux Mechanism Mandatory?

“…The convexity of the papilla neutralises the high hydrostatic pressure wave and thus prevents intrarenal reflux. As repeatedly demonstrated, intrarenal reflux is the cause of pyelonephritic scarring, be it by the high pressure of sterile urine or, in the case of infected urine, by massive intratubular invasion of micro-organisms (Rose et al, 1975;Bourne et al, 1976). This explains why reflux, without urinary tract infection, can lead to renal failure (Salvatierra et al, 1973;Bakshandeh et al, 1976).…”

Dr. M. Moncrieff comments

“…Moreover if intrarenal reflux can be shown, focal renal scarring may develop in the areas of affected renal parenchyma (Rolleston et al, 1974;Uldall et al, 1976;Bourne et al, 1976). The significance of intrarenal reflux has been confirmed in studies of the pathogenesis of reflux nephropathy in the pig experimental model (Hodson et al, 1975).…”

Unique Consequences of Kidney Infections in Infants and Children: Pathogenesis, Early Recognition, and Prevention of Scarring

“…These authors de scribed IRR in 6.7% of children less than 5 years of age and noted that 65% of children with IRR had scarring of the parenchyma in areas adjacent to refluxing papillae. Bourne et al [55] analyzed cystograms from 59 children less than 6 years of age with recurrent UTI and found IRR in 8 patients (13%). Renal parenchymal thinning was noted opposite the areas of IRR in 7 of 8 children.…”