Reflux nephropathy

About

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Reflux nephropathy is kidney damage caused by vesicoureteral reflux (VUR) — a condition in which urine flows backward from the bladder into the ureters and sometimes the kidneys. This backward flow can lead to repeated urinary tract infections (UTIs), kidney scarring, and impaired kidney function over time.

The condition is often diagnosed in children, though adults may also be affected. Early identification and treatment of reflux nephropathy are crucial to prevent chronic kidney disease and long-term complications.

Is it common?

Vesicoureteral reflux occurs in approximately 1–2% of children, but not all develop reflux nephropathy. Children with recurrent UTIs, abnormal kidney ultrasounds, or family history of VUR are at higher risk. Reflux nephropathy is a significant cause of childhood kidney scarring and can contribute to hypertension and chronic kidney disease in adulthood.

Can it be cured?

There is no guaranteed cure for reflux nephropathy once scarring has occurred. Treatment aims to prevent further kidney damage through infection control, management of reflux, and monitoring kidney function. Early intervention, especially in children, can prevent progression and preserve long-term kidney health.

Causes

What causes Reflux Nephropathy?

The main causes include:

  • Primary VUR: congenital abnormality of the ureterovesical junction allowing urine to flow backward
  • Secondary VUR: caused by increased bladder pressure due to obstruction, neurogenic bladder, or other structural abnormalities
  • Recurrent UTIs: infections exacerbate kidney inflammation and scarring
  • Genetic predisposition: family history of VUR increases risk

Repeated infection and reflux lead to glomerular scarring and tubular damage, which impairs kidney function over time.

With Insurance

Nephrology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$169
Initial Visit
$109
Follow Up

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Symptoms

Symptoms

Symptoms may vary depending on age and severity:

  • Recurrent urinary tract infections (fever, pain, burning with urination)
  • High blood pressure in children or adults
  • Proteinuria or hematuria detected on urine testing
  • Kidney enlargement or asymmetry detected on imaging

Often, young children may be asymptomatic, and the condition is discovered during evaluation for UTIs

Diagnosis

Diagnosis involves imaging, laboratory tests, and sometimes functional studies:

Imaging

  • Renal ultrasound — evaluates kidney size, scarring, or hydronephrosis
  • Voiding cystourethrogram (VCUG) — gold standard to detect reflux
  • DMSA scan — detects kidney scarring and differential kidney function

Laboratory Tests

  • Urinalysis and urine culture to detect infection
  • Blood tests: serum creatinine, BUN, eGFR for kidney function

Treatment

Treatment depends on the severity of reflux, kidney damage, and risk of infections:

Medical Management

  • Continuous low-dose antibiotic prophylaxis to prevent recurrent UTIs
  • Management of high blood pressure with ACE inhibitors or ARBs
  • Routine monitoring of kidney function and urine protein

Surgical Management

  • Ureteral reimplantation or endoscopic correction for severe or persistent VUR
  • Surgical intervention is more common in children with high-grade reflux or progressive kidney damage

Long-Term Care

  • Early detection and intervention can prevent further scarring
  • Lifelong monitoring may be required to detect hypertension or chronic kidney disease

References

  • Kidney Disease: Improving Global Outcomes (KDIGO) 2021 Clinical Practice Guideline for Pediatric and Adult VUR
  • National Kidney Foundation – Reflux Nephropathy Overview
  • Mayo Clinic – Vesicoureteral Reflux and Kidney Scarring
  • American Urological Association (AUA) – VUR Guidelines
  • American Society of Nephrology (ASN) – Reflux Nephropathy Resources
  • UpToDate – “Reflux Nephropathy: Clinical Features and Management”
  • StatPearls – Reflux Nephropathy Review
  • NIDDK – Kidney and Urinary Tract Disorders

Medically reviewed by:

Dr. Javeed Siddiqui, MD, MPH

Dr. Siddiqui is the Chief Medical Officer at TeleMed2U responsible for clinical and technical program development as well as maintaining a thriving telemedicine practice in infectious diseases which includes specialized care of Hepatitis and HIV.

Meet our doctors

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Affordable – with or without insurance

With Insurance

Nephrology

Your copay
Depending on insurance

Without Insurance

*Price Effective 12/1/2025
$169
Initial Visit
$109
Follow Up

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