Re: Vesicoureteral Reflux

Posted By HFHS M.D.-MS on January 22, 1998 at 10:28:52:

In Reply to: Vesicoureteral Reflux posted by E. Johnson on January 21, 1998 at 10:43:18:








My 40 year old husband received a kidney transplant last year after a life-time of reflux (grade 4, both sides), but was never diagnosed with a UTI in his life.
Because of his history, our two daughters have both had VCUG's done.   Our 3 year old was grade 1 as an infant, and is now grade 2-3, although only on the left side.
Our 4 month old baby is grade 4 on the right side, grade 2 on the left.  Both are on antibiotics to control infection, although neither have ever been diagnosed with an infection.  
My question:   Is it true that the medical community no longer accepts the "pressure" theory -  that kidney scarring/damage can occur because of the increased pressure on the kidneys when the urine backs up?  We have been told that this pressure theory is on longer valid, and that the only way that reflux can cause kidney damage is when the reflux causes a UTI. Even though my girls have not had UTI problems, I am still very concerned about damage being done, since my husband never had a UTI (that we know of), and still managed to lose his kidneys.  
Thank you for your response!




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Dear Mrs. Johnson :
Thank you for your question.
As you may know reflux disease  occurs when the urine tube ( ureter) from the kidney does not connect with the bladder in the normal way, and therefore, does not form a one way valve for urine flow.  This incompetent valve  allows urine to freely flow back up the ureter and to the kidney.  Normal bladders store urine at very low pressures until full. When emptying the pressure increases temporally.  
The pressure theory  you mention suggests that pressure  can cause renal damage if this is long-standing and not relieved. This is seen in an obstructing kidney stone or in neurological conditions which will not let the normal ureteral  valve mechanism open because of the    back    pressure  from the bladder.  Temporary back pressure  of reflux seen when voiding is reportedly not a factor.    The current thought is that reflux by itself does not cause renal damage, unless it is  very severe, Grade 5 .  Damage occurs when infection freely flows back up the ureter and involves the kidney.  Children are susceptible because their  kidneys are not fully developed and still growing.   As you know, most children are notorious for fevers, and coughs etc.  It is believed  that most UTIs can go unnoticed but treated  in the very young because they are treated with antibiotics for a suspected upper respiratory infection, when the real culprit is in the urine.  Scarring of the kidney can be progressive and can occur with only one infection.  In fewer cases, this scarring can lead to high blood pressure which damages the kidneys further.
When reflux disease is treated medically kidney function must be monitered closely with radiologic studies, blood tests, and urine tests.  If renal function is comprimised or breakthrough infections occur, surgical correction of the reflux is recommended.
                
This information is provided for general medical education purposes only.  Please consult your physician for diagnostic and treatment options pertaining to your specific medical condition.
More information can be obtained about kidney diseases at Nephron.com website.  
More individualized care is available at the Henry Ford Hospital and its satellites (1 800 653 6568).
Good Luck With the Refluxers:
HFHS-M.D., MS
*Keyword: Vesicoureteral Reflux