Reflux Nephropathy Due To Asymptomatic Vesicoureteral Reflux Until The Age of 5

Background and Aims: Vesicoureteral reflux (VUR) is an abnormal condition in which urine flows retrograde from the bladder into the ureters and kidneys. Vesicoureteral reflux can be primary or secondary. Girls,white children, infants and children up to age of 1 year appear to have a higher risk of vesicoureteral reflux.

Methods: A 5-year-old girl came on exame for routine laboratory tests of blood and urine. She was previosly healthy girl, with rare upper respiratory tract infections. Her mother was complaining on her child’s poor appetite since her birth and weakness over the last period. There were no signs of urinary tract infection(UTI). Body weight and length were in the normal range of standard deviation.

The laboratory findings were: normal blood test, elevated serum C-reactive protein.Urine analysis showed: >100 leukocytes, 4-5 erythrocytes, bacteria (+++). Urine culture: Escherichia coli 1000000/ml.

Results: The ultrasonography of the abdomen confirmed bilateral hydronephrosis grade 1 and smaller size of the right kidney. Left kidney was compensatory enlarged with an uneven surface.

99mTc-DMSA showed renal fixation LK/RK=90/10%. Right kidney showed reduction of the parenchyma and hypofixation of the whole kidney. Left kidney was enlarged,inhomogeneous, with hypofixation of the upper and lower half.

Intravenous urography excluded presence of kidney stones,confirmed bilateral hypotonia of ureters and hypoplasia of the right kidney.

Cystourethrography during micturition showed VUR with dilatation of the left ureter distally of grade III.

Direct radionuclide cystography confirmed VUR lat. sin. of grade II-III and retention of the urine.

Conclusions: Early diagnosis of VUR is very important because of the prevention of episodes of acute pyelonephritis and kidney damage. Untreated UTI can lead to scarring, also known as reflux nephropathy, which is a permanent damage to the kidney tissue. Extensive scarring may lead to high blood pressure and can increase the risk of hypertension and renal failure in children and adults.