obsolete unilateral vesicoureteral reflux with reflux nephropathy

Vesicoureteral Reflux (VUR) and Reflux Nephropathy

Vesicoureteral reflux (VUR) is a condition characterized by the retrograde flow of urine from the bladder into the ureters, sometimes reaching the kidneys. This can lead to renal scarring and reflux nephropathy, which carries a risk of subsequent hypertension and toxemia of pregnancy [1][3].

Increased Risks

The increased risks associated with VUR include:

• Urinary tract infections (UTIs)
• Renal scarring
• Reflux nephropathy

These complications can have long-term consequences for individuals affected by VUR, making early detection and treatment crucial [4][5].

Reflex Disappearance of Reflux

In some cases, the reflux in children with vesicoureteral reflux may disappear over time. However, this is not a universal outcome, and population-based studies are needed to fully understand the long-term effects of VUR on renal health [6].

Primary VUR

The primary form of VUR is defined as reflux due to anatomical or functional defects at the vesicoureteric junction. This condition can be identified through various diagnostic methods, including imaging and urodynamic studies [8][9].

References:

[1] TK Mattoo (2007) - Cited by 42 [3] G Läckgren (2021) - Cited by 67 [4] G Läckgren (2021) - Cited by 67 [5] M Wennerström (1998) - Cited by 148 [6] H Miyakita (2020) - Cited by 68 [7] Not provided in the context [8] O Sarhan (2020) - Cited by 2 [9] Not provided in the context

Based on the provided context, it appears that there are several diagnostic tests used to diagnose and evaluate vesicoureteral reflux (VUR) and its associated complications, such as reflux nephropathy. Here's a summary of the relevant information:

• Voiding Cystourethrography (VCUG): This is considered the definitive method for diagnosing VUR and helpful in determining the need for further evaluation or treatment ([9]). VCUG involves injecting a contrast agent into the bladder while the patient urinates, allowing for visualization of the ureters and kidneys.
• Radionuclide Cystography: This test uses a small amount of radioactive material to visualize the urinary tract and diagnose VUR. It is often used in conjunction with other imaging studies ([11], [14]).
• Renal Ultrasonography: This non-invasive imaging study can detect congenital renal and urinary tract anomalies, as well as hydronephrosis that may be associated with VUR ([8]). However, it is not considered a definitive diagnostic test for VUR.
• DMSA Renal Scintigraphy: This nuclear medicine test can help assess the function of the kidneys and detect any scarring or damage due to VUR ([5], [10]). It involves injecting a small amount of radioactive material into the bloodstream, which is then concentrated in the kidneys.

It's worth noting that the diagnosis of reflux nephropathy is often made based on clinical history, imaging studies, and laboratory tests, rather than a specific diagnostic test. The exact mechanism for renal scarring following UTI is not known, but it is believed to be mediated by immunological mechanisms, macromolecular trapping, and mesangial dysfunction ([10]).

In the case of obsolete unilateral vesicoureteral reflux with reflux nephropathy, the diagnostic tests mentioned above may still be useful in evaluating the extent of kidney damage and determining the best course of treatment. However, it's essential to consult with a healthcare professional for personalized advice and guidance.

References:

[8] Nov 1, 2010 — Renal ultrasonography is the safest and fastest method for detecting congenital renal and urinary tract anomalies as well as hydronephrosis that ...

[9] by G Läckgren · Cited by 67 — Voiding cystourethrography (VCUG) is generally considered the definitive method for diagnosing VUR, and helpful in determining the need for further evaluation or treatment.

[10] The exact mechanism for renal scarring following UTI is not known, but is believed to be mediated by immunological mechanisms, macromolecular trapping and mesangial dysfunction, vascular alterations, hypertension and hemodynamic alterations 1.Renal scarring due to intrarenal reflux occurs mostly at the renal poles because the presence of extensively fused (compound) renal papillae, which are ...

[11] The diagnosis is suspected in children with urinary tract infections or a family history of reflux nephropathy, or if a prenatal ultrasound shows hydronephrosis. Diagnosis is by voiding cystourethrography or radionuclide cystography.

[14] This activity describes the evaluation, diagnosis, and management of reflux nephropathy and illustrates the role of team-based interprofessional care for affected patients. Objectives: Describe the different presentations of reflux nephropathy. Review the evaluation of reflux nephropathy.

Treatment Options for Obsolete Unilateral Vesicoureteral Reflux (VUR) with Reflux Nephropathy

For children with obsolete unilateral VUR and reflux nephropathy, the primary goal is to prevent further kidney damage. While surgical options are often considered for more severe cases, drug treatment can be a viable alternative for mild or moderate cases.

Antibiotic Prophylaxis

According to search result [5], antibiotic prophylaxis is recommended for all grades of VUR in children aged 1-5 years old. This involves taking antibiotics regularly to prevent UTIs and subsequent kidney damage. However, the effectiveness of this approach may vary depending on individual cases.

Trimethoprim-Sulfamethoxazole

Search result [8] mentions that trimethoprim-sulfamethoxazole is one of the most common antibiotics used for treating VUR in older children. This medication has been shown to be effective in preventing UTIs and reducing the risk of kidney damage.

Nitrofurantoin

Another antibiotic mentioned in search result [8] is nitrofurantoin, which is also commonly used to treat VUR in children. While its effectiveness may vary depending on individual cases, it can be a useful option for some patients.

Penicillins and Cephalosporins

Search result [8] also mentions that penicillins and cephalosporins are used as alternative antibiotics for treating VUR in older children. These medications can be effective in preventing UTIs and reducing the risk of kidney damage, but their use may depend on individual cases.

Limitations and Considerations

It's essential to note that while drug treatment can be a viable option for obsolete unilateral VUR with reflux nephropathy, it may not be suitable for all cases. The effectiveness of antibiotic prophylaxis or other medications may vary depending on individual factors, such as the severity of VUR, kidney function, and overall health.

References

• Search result [5]: Mattoo TK. (2003). Vesicoureteral Reflux: A Review.
• Search result [8]: Guidelines for the Prevention and Treatment of Urinary Tract Infections in Children. (2011).

Please consult a healthcare professional for personalized advice on treating obsolete unilateral VUR with reflux nephropathy.

Differential Diagnosis of Obsolete Unilateral Vesicoureteral Reflux with Reflux Nephropathy

Unilateral vesicoureteral reflux (VUR) is a condition where urine flows from the bladder back up into the ureter and sometimes to the kidney. When this condition leads to renal scarring, it's referred to as reflux nephropathy. The differential diagnosis of obsolete unilateral VUR with reflux nephropathy involves identifying other conditions that may cause similar symptoms.

Possible Causes:

• Chronic Pyelonephritis: This is a type of kidney infection that can lead to scarring and damage to the kidneys.
• Renal Masses: These are abnormal growths on the kidneys that can be caused by various factors, including infections or tumors.
• Intrarenal Reflux: This is a condition where urine flows from the ureter back into the kidney, causing damage and scarring.

Key Points to Consider:

• The presence of renal scarring and damage suggests that the condition has been ongoing for some time.
• The unilateral nature of the VUR indicates that it affects only one side of the urinary tract.
• Reflux nephropathy is a known complication of untreated or poorly managed VUR.

References:

• [11] Mechanisms of renal damage in chronic pyelonephritis (reflux nephropathy). Review. Curr Top Pathol. 1995;88:265–287. doi: 10.1007/978-3-642-79517-6_9.
• [12] Vesicoureteral reflux (VUR) is the retrograde urine flow from the urinary bladder to the upper urinary tract, usually during voiding. A short intramural ureter often causes this abnormal backward flow of urine.

Citations:

[11][12]