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Reflux Nephropathy - What is the treatment for reflux nephropathy?

 

What is the treatment for reflux nephropathy?


What you can do yourself

No treatment guarantees that reflux will not cause problems, but you can help yourself enormously. If recurrent infections are a problem, it is best to take a high fluid intake, and avoid alcohol during an infection. It is best to empty your bladder fully when you go to the toilet, and empty your bladder after sex. For more details on urine infections, click here.

If you have high blood pressure or kidney damage from reflux nephropathy, make sure you have a good understanding of the condition, and work with your doctors and other staff to develop effective treatment strategies. Some medication, especially high blood pressure treatment, can cause side effects. Discuss these honestly with the doctor or pharmacist, and do not just stop taking medication without telling anyone.

Treatment of urine infections

As well as the self-help measures identified above, antibiotics are often needed to treat urine infections. In a few cases, people can eliminate an infection by raising fluid intake, but antibiotics need to be prescribed most of the time. Remember to tell the doctor if you have any allergies, and take the full course even if you feel better after the first day or two.

Some people get repeated infections. There are several strategies that can be used to deal with these, and the one which suits each person best should be discussed with the specialist. Do remember, though, that the doctor wants not only to treat any unpleasant symptoms you get from an infection, but also to prevent damage to the kidneys and reduce the chances of getting kidney failure in the long term. The four strategies most often used are:-

  1. Take a single course of antibiotic, ideally after a sample of urine has been sent to the laboratory to test for germs.
  2. Some people get ill quickly from infections, and keep some antibiotics at home to start themselves at the first sign of infection, so avoiding delay. Ideally, they should also collect a sample of urine for culture before starting the antibiotic.
  3. Some people get a series of infections one after the other, coming back as soon as antibiotics are stopped. A three month course of antibiotics, at a daily low dose, may then be tried. In many cases this is effective, and antibiotics can then be stopped. Long term antibiotics are usually well tolerated, but can cause problems with sickness or diarrhoea or thrush (itchy infection in the genital area). If an infection ‘breaks through’ preventative antibiotics, it may be resistant to the antibiotic, but this is not usually a problem as there are many different types of antibiotic available, and a different type of antibiotic will generally work quickly.
  4. Rarely, even a three month course of preventative antibiotics fails, and it may be necessary to take a daily antibiotic for longer, even years in some cases. In some people a single type of antibiotic seems to work, in others it is best to ‘rotate’, that is, to take a different antibiotic each month. This is thought to reduce the rate of breakthrough infection and antibiotic resistance. Most doctors rotating antibiotics would use three different types.

Surgery for reflux nephropathy

A surgeon can operate on a ureter with reflux. The most commonly performed operation ‘tunnels’ the ureter under the surface of the bladder, trying to get it to the position it should have been in at birth. Although an operation may look technically successful, research over the last 30 years has shown that it does not necessarily make people better. The indications for surgery have therefore been defined more clearly, and surgery for reflux is carried out far less often than 30 years ago.

It is still not proven exactly which people should have surgery, and not all surgeons agree.

The general consensus is that once scarring or kidney failure have started, surgery does not protect a kidney against further damage. Surgery carried out before the age of 3 years in children with severe reflux may prevent kidney damage later in life. Some adults with loin pain when the bladder is full may benefit from surgery.

A kidney which has been very badly damaged by reflux may be removed completely, to prevent further infections or to help with blood pressure control. Obviously this is a last resort, in a kidney which has virtually no function left.


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.

NKF Controlled Document No. 14: What is the treatment for reflux nephropathy? written: 28/10/2002 last reviewed: 16/03/2015