Primary Vesicoureteric Reflux and Reflux Nephropathy - New Insights

Abstract

Primary vesicoureteric reflux was felt to result from a congenitally short mucosal tunnel length with oblique intravescical insertion but more recent data suggest that primary vesicoureteric reflux is often associated with functional urodynamic abnormalities. There is now sound evidence that primary vesicoureteric reflux has a familial basis; most findings suggest a dominant inheritance with incomplete penetrance. Primary vesicoureteric reflux is often associated with kidney damage, mostly referred to as reflux nephropathy. It has been traditionally assumed that in primary vesicoureteric reflux kidney damage results from reflux of infected urine into the renal tissue but recent observations indicate that kidney damage sometimes occurs prenatally. In the overwhelming majority of patients with prenatally acquired renal damage the damage is linked with high-grade vesicoureteric reflux. In conclusion there are two categories of reflux disorder: a reflux associated with an acquired renal scarring secondary to infections and a prenatal high-grade vesicoureteric reflux linked with a congenital nephropathy.