Reflux nephropathy
Reflux nephropathyReflux means that something goes back the way it has come, instead of travelling onwards. In reflux nephropathy, this means that urine passes back up from the bladder towards the kidneys, instead of coming out of the body (click here for a picture of the bladder, kidneys and drainage tubes). Nephropathy is a medical term for kidney disease.
Reflux nephropathy is sometimes also called just “reflux”, and an older name for the same condition is “chronic pyelonephritis”, or “chronic pyelonephritis with reflux”. It is sometimes also called “vesico-ureteric reflux”. “Vesico-ureteric” means from the bladder to the ureter (the tube from bladder to kidney).
Nearly all cases of reflux are caused by an abnormality that develops before birth. One or both of the drainage tube from the kidneys to the bladder (called ureters) enter the bladder at the wrong angle. When the bladder contracts to pass urine outwards, the ureter is not “pinched off”, and instead of all the urine being passed out of the body, some goes back up the ureters towards the kidneys.
Sometimes, reflux can be secondary to other problems that have developed during life, such as bladder disease or radiation to the ureters. Reflux can also occur after kidney transplantation. 
There are many causes of infection in the urine. Most people with urine infections do not have reflux nephropathy. Any abnormality in the drainage system from the kidneys, or abnormality in the bladder, can lead to urine infections. Although urine has no germs in it when it leaves the kidneys, if it does not leave the body right away, germs can grow very fast as urine is an extremely “fertile” breeding ground.
However, urine infections in babies and young children are an important sign of possible reflux nephropathy. Tests should be performed to make sure reflux is not present, especially if urine infections in babies are repeated.
Reflux nephropathy can show itself in a number of ways. It can occasionally be detected before birth, using an ultrasound scan of the baby in the womb. The scan may show evidence of back pressure from the bladder on developing kidneys. Most often, reflux is detected because a child has urine infections. Occasionally, urine infection does not cause typical pain, but can cause bedwetting. Most children with bedwetting do not have reflux nephropathy, but a simple urine test should detect whether urine infection is present.
Not usually, but it can occur. Infection usually causes pain, which may be in the groin. A burning feeling while passing urine is the most common, but there may also be smelly urine and itching. If infection affects the kidney, there may be pain in the loin. The back pressure caused by the reflux of urine does not often cause pain, though this can happen. In adults, pain of this type is very occasionally helped by surgery (see below)
Reflux of urine is common, occurring in 1 in 100 children. In many cases this causes no problems. The majority of reflux then disappears during childhood, in about 9 out of 10 cases. However, some kidney damage can also occur at an early age, and children with reflux require careful treatment.
Reflux nephropathy requires tests to be performed before a firm diagnosis can be made. The simplest is an ultrasound (sound wave) scan of the bladder and kidneys. To prove a diagnosis of reflux, a test called a micturating cystogram might be performed. This requires a catheter (small tube) to be inserted into the bladder, and X-ray dye to be injected into the bladder.
Women with reflux nephropathy normally have successful pregnancies. However, there is an increased risk of urine infection during pregnancy. If there is protein in the urine or scarring on the kidneys, there is an increased risk of high blood pressure, and this requires careful management. If someone with severely damaged kidneys from reflux nephropathy wants to get pregnant, the risks depend upon the exact level of kidney function. 
There is much someone with reflux nephropathy can do for themselves to reduce the risk of infections and other problems.
Treatment and prevention of urine infections is the most important treatment for reflux, and sometimes this requires long term antibiotic treatment.
It is possible for a surgeon to perform an operation that is designed to reduce the reflux of urine. Research has shown that this surgery is necessary in only a very few people with reflux. These are children with very severe reflux, and adults with painful reflux.
The most frequent complication of reflux nephropathy is urine infection. Other complications include high blood pressure, kidney stones, kidney pain and kidney failure.
If someone with reflux nephropathy develops complete kidney failure, dialysis and transplantation can usually be given in the same way as for anyone else. Some people with recurrent urine infections may need to have their own kidneys removed to make kidney transplantation safer.
Reflux nephropathy can run in families, and scarring to the kidneys can develop at an early age. Therefore family screening is recommended.
There is at present no genetic test that can be done to see if someone has reflux nephropathy. Therefore screening consists of tests on the kidneys and bladder to look for evidence of reflux.
NKF Controlled Document No. 11, Reflux nephropathy, written 28 October 2002. Last reviewed 27 October 2008.
The National Kidney Federation cannot accept responsibility for information provided. The above is for guidance only. Patients are advised to seek further information from their own doctor.
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Page created: 28 October 2002
Last updated: 29 April 2009
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What is reflux nephropathy?