Long-term outcome of vesicoureteral reflux and reflux nephropathy in adults - clinical and radiological aspects

Abstract: The aim was to study the long-term consequencies of vesicoureteral reflux and reflux nephropathy (RN) in adults, with regard to radiological progression, urinary tract infections, renal functional impairment, hypertension, and to determine if the extent of renal damage can predict the outcome. Attempts to differentiate between acquired and developmental renal damage were also made. 115 patients with reflux were identified at a median age of 28 years and were followed clinically and radiologically for a median of 16 years. Half of the patients had antireflux surgery performed. Urographic renal damage was graded and related to the clinical outcome. Renal damage was found in 87% of the patients, and a history of acute pyelonephritis (APN) in 72%. Urographic and histological (n=25) analyses did not reveal maldevelopment as a cause of renal damage, but a family history of urinary tract disorders was common, suggesting that genetic factors are of importance. Renal function deteriorated in 25 patients and 16 reached end-stage renal disease. Urographic progression of renal damage occurred in only 4 of 120 kidneys, despite APN and persisting reflux. Therefore, repeated urography in adults with RN is rarely justified. Antireflux surgery in adults appears beneficial in relieving loin pain, but did not prevent renal functional deterioration, and reduction in APN frequency was comparable with that of conservative treatment. Urographic grading of renal damage can predict the risk of deterioration of renal function, but not of hypertension. Early detection and treatment of APN in childhood appear to be important measures in the long-term prevention of renal damage and subsequent functional deterioration.