Reflux nephropathy
The term reflux nephropathy encompasses radiologically visible tissue changes in certain functional cells of the kidney ( nephron ).
root cause
Reflux nephropathy is caused by reflux of urine into the renal pelvis , mostly due to congenital malformations of the lower urinary tract (Congenital Anomalies of Kidney and Urinary Tract, CAKUT for short). The healthy ureter guides the urine from the renal pelvis into the bladder through peristaltic waves of its smooth muscles . A backflow of urine from the urinary bladder in the direction of the renal pelvis is normally not possible, as the peristaltic waves always run away from the renal pelvis towards the urinary bladder and the ureter forms a kind of valve due to its course before the confluence with the bladder.
In childhood, half of all urinary tract infections are caused by reflux nephropathy, compared to only five percent in adults.
Diagnosis
An anatomical, obstructive anomaly must be excluded. A micturition cystourethrogram can be used for functional diagnostics. An IV pyelogram is used to show scars and calyx deformations . This can be replaced by a dimercaptosuccinic acid scan, especially in children .
classification
Reflux is divided into five grades:
- Grade I: Reflux does not reach the renal pelvis
- Grade II: reflux reaches the renal pelvis, no dilation of the cavity system
- Grade III: slight or moderate dilatation of the ureter , fornices largely normal
- Grade IV: moderate dilatation of the ureter, fornices plumped
- Grade V: severe dilatation of the ureter
therapy
Perinal hygiene plays an important role in children. Long-term prophylaxis with antibiotics is possible. There is also surgical correction by means of antireflux surgery. A conservative approach is to try to omit antibiosis (in the case of negative urine cultures).
In adults, urinary tract infections and secondary hypertension are treated. In the case of young women with antibiotic resistance, surgical rehabilitation is an option at a pronounced stage.
literature
- Rolf Beetz, Joachim Wilhelm Thüroff, Raimund Stein: Pediatric urology in clinic and practice. Thieme, Stuttgart 2011. ISBN 978-3-13-159323-8 . P. 350f.
- Helmut Geiger: Kidney diseases: pathophysiology, diagnostics and therapy. Schattauer Verlag, 2003. ISBN 3794521773 . P. 192
- Thomas Göttsche: Introduction to Radiology: Diagnostics and Interventions. Thieme, Stuttgart 2006. ISBN 978-3-13-316011-7 . P. 583ff.
- Christine K. Keller: Practice of Nephrology. Springer, 2013. ISBN 9783662094143 . P. 116ff
