Reflux Nephropathy in Adults

Zucchelli, P; Gaggi, Rossella

doi:10.1159/000186207

Cited by 19 publications

(16 citation statements)

References 31 publications

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“…Degree of reflux and the degree of scarring [3,18,26,85], much higher than that in children, and is commonly associated with proteinuria and renal…”

Section: Risk Factors For the Development Of Hypertensionmentioning

confidence: 99%

“…These subjects would thus not qualify for antihypertensive therapy (e.g. ACE inhibitors) until a later of hypertension or other complications [26,61]. There is no diCerence in new scar development or the progression stage in their condition, when much renal damage might have occurred.…”

Section: Managementmentioning

confidence: 99%

“…There are also data indicating a relationship between the degree of VUR and the extent of the that had been used for many years [1]. The presence of primary VUR and UTI with no urinary obstruction would scarring [24,25], although there is some disagreement on this issue [9,26], and between the degree of scarring, appear to be prerequisites for Bailey's definition, but the situation is not simple.…”

Section: Introductionmentioning

confidence: 99%

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Hypertension in reflux nephropathy

Goonasekera

Dillon

1999

BJU International

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“…Degree of reflux and the degree of scarring [3,18,26,85], much higher than that in children, and is commonly associated with proteinuria and renal…”

Section: Risk Factors For the Development Of Hypertensionmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypertension in reflux nephropathy

Goonasekera

Dillon

1999

BJU International

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“…7,8,10,11 There is a correlation between the extent of scarring and grade of VUR 12,13 although there is some disagreement on this issue. 14 It is also clear that renal scars may be seen in the absence of demonstrable VUR. 15 It is considered that renal scarring mainly occurs in younger subjects (Ͻ5 years).…”

Section: What Is Reflux Nephropathy?mentioning

confidence: 99%

“…There is evidence that anti-reflux surgery has helped significantly to reduce the number of urinary tract infections but not the incidence of hypertension or other complications. 14,22 There is no difference if a comparison is made between medical and surgical management in terms of new scar development or the progression of renal scars. 118 The Birmingham Reflux Study Group compared operative versus nonoperative management of children with gross reflux over 5 years and concluded that neither treatment can claim superiority in terms of reducing the incidence of breakthrough UTI, renal excretory function, concentrating ability, renal growth, progression of existing scars, or new scar formation.…”

Section: Managementmentioning

confidence: 99%

Reflux nephropathy and hypertension

Goonasekera

Dillon

1998

J Hum Hypertens

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Renal scarring associated with vesico-ureteric reflux (VUR), most commonly detected in young children, is associated with a significant risk of developing hypertension in later life. Hypertension in reflux nephropathy contributes significantly to morbidity including deterioration of renal function. The mechanism of onset of hypertension is not clear although abnormalities of the renin-angiotensin system and sodium/potassium ATPase activity have been described in some cases. It is becoming clear that radiologically detectable renal scars or small kidneys may histologically indicate a variety of diagnoses. Prediction of the risk of developing hypertension in individual cases is difficult and there-

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Up-regulation of angiotensin-converting enzyme (ACE) gene expression induces tubulointerstitial injury in reflux nephropathy

Chertin

Solari

Reen

et al. 2002

Pediatric Surgery International

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Reflux nephropathy (RN) is the cause of end-stage renal failure in 3%-25% of children and 10%-15% of adults. Angiotensin-converting enzyme (ACE) converts the inactive decapeptide angiotensin I (Ang I) to the active octapeptide angiotensin II (Ang II), a potent vasoconstrictor. ACE is localized in highest concentrations on the luminal surface of endothelial cells, but is also found in several other cell types, including the epithelial cells of the proximal renal tubule. Recent studies have suggested that ACE increases production of the components of extracellular matrix (ECM) such as fibronectin (Fib) mediated through Ang II. Since RN is a primary tubulointerstitial disease, we hypothesized that local overexpression of ACE may induce renal fibrosis via up-regulation of Ang II. In this study, we investigated the expression of ACE in severely refluxing kidneys from eight patients (age range 6 months-14 years) with severe RN secondary to primary high-grade vesicoureteral reflux at nephrectomy. Control material included normal kidney specimens obtained from three adult patients during partial nephrectomy for an incidentaloma. Soluble enzyme immunohistochemistry was carried out using polyclonal antibodies to ACE and Fib. In-situ hybridization (ISH) was performed utilizing biotin-labelled antisense oligonucleotide probe. Reverse transcription-polymerase chain reaction (RT-PCR) was performed to evaluate the relative amount of ACE mRNA. In the refluxing kidney, there was strong ACE immunoreactivity in the glomerulus and proximal tubules and moderate-to-strong immunoreactivity in the distal tubules accompanied by strong Fib immunoreactivity in the glomerulus, proximal tubule, and interstitial space. There was strong ACE mRNA expression in the glomerulus and proximal tubules and moderate expression in the distal tubules. In the control kidneys, homogeneous weak ACE immunoreactivity and mRNA expression was demonstrated only in the proximal tubules. RT-PCR showed strong ACE expression in the refluxing kidneys compared to controls. Up-regulation of ACE in RN accompanied by an increase in ECM in the tubulointerstitial space suggests that ACE is involved in the pathogenesis of the renal parenchymal damage in patients with RN. Pharmacologic blockade of ACE may be helpful in preventing the renal fibrosis associated with RN.

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Reflux Nephropathy in Adults

Cited by 19 publications

References 31 publications

Hypertension in reflux nephropathy

Hypertension in reflux nephropathy

Reflux nephropathy and hypertension

Up-regulation of angiotensin-converting enzyme (ACE) gene expression induces tubulointerstitial injury in reflux nephropathy

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