Vesicoureteral reflux, reflux nephropathy, and end-stage renal disease.
OBJECTIVE
To review the contribution of vesicoureteral reflux and reflux nephropathy to end-stage renal disease.


METHODS
Published research articles and publicly available registries.


RESULTS
Vesicoureteral reflux (VUR) is commonly identified in pediatric patients and can be associated with reflux nephropathy (RN), chronic kidney disease (CKD), and rarely end-stage renal disease (ESRD). Patients with reduced GFR, bilateral disease, grade V VUR, proteinuria, and hypertension are more likely to progress to CKD and ESRD. Because progression to ESRD is rare in VUR and often requires many decades to develop, there are limited prospective, randomized, controlled trials available to direct therapy to prevent progression to ESRD.


CONCLUSIONS
Identification of patients with increased risk of progression to CKD and ESRD should be the goal of clinical, biochemical, and radiological evaluation of patients with VUR. Treatment of patients with VUR should be directed at preventing new renal injury and preserving renal function.
Brakeman
Paul
P
Division of Pediatric Nephrology, Department of Pediatrics, University of California, San Francisco, CA 94143-0532, USA. brakemanp@peds.ucsf.edu