Reflux Nephropathy

Key points

• Reflux nephropathy describes chronic renal parenchymal scarring associated with vesicoureteric reflux (VUR), often in the context of recurrent febrile UTI and/or congenital urinary tract abnormalities.
• Do not call it simply 'chronic pyelonephritis caused by VUR'. Reflux-associated renal scarring is the key pathological concept.
• High-grade VUR with recurrent UTI is strongly associated with renal scarring; scarring can lead to hypertension, proteinuria and CKD.
• Renal injury can occur in childhood , but the statement that scarring 'usually occurs in the first 5 years' is too rigid and should not be memorised as a universal rule.
• Familial/genetic predisposition to VUR and congenital renal abnormalities exists , but 'strong genetic disposition' should not be treated as a diagnostic criterion.
• MRCP discriminator: recurrent febrile UTI + VUR/renal scars + later hypertension or proteinuria → reflux nephropathy.
• NICE point: children with bilateral renal abnormalities, impaired kidney function, raised BP or proteinuria require appropriate nephrology monitoring.