Department of Pediatric Nephrology, Perth Children's Hospital, Perth, Western Australia, Australia.
Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione Ca' Granda IRCCS, Policlinico di Milano.
Curr Opin Pediatr. 2021 Apr 1;33(2):247-251. doi: 10.1097/MOP.0000000000000996.
The aim of this review is to highlight the most recent developments in the understanding of kidney damage associated with vesico ureteral reflux. The severe damage, with major adverse long-term sequelae, was thought to be, for the most part, the result of pyelonephritis, predisposed to by vesico ureteral reflux.
It is now recognized that there are two distinct forms of kidney damage (congenital and acquired), in association with reflux. We examined the most recent research regarding these two conditions.
The most recent articles focus on an understanding and the possible interventions for the congenital and acquired abnormalities of the kidney, associated with reflux. Of particular interest in congenital disorders, is the importance of urothelium and gene mutations in normal and aberrant development of the urinary tract. As regards the predisposition to urinary tract infections and kidney scarring, the importance of uromodulin in the defence mechanism preventing infection, and the role of interventions aimed at reducing scarring, such as vitamin A and steroids during the acute phase of the infection, are discussed. A recent article of particular value demonstrated the absence of long-term adverse outcomes during pregnancy, in women investigated for urinary tract infections in childhood.
本文旨在强调在理解与膀胱输尿管反流相关的肾损伤方面的最新进展。严重的肾损伤会导致重大的长期不良后果，人们普遍认为，大部分严重肾损伤是由肾盂肾炎引起的，而肾盂肾炎易由膀胱输尿管反流引起。
现在已经认识到，与反流相关的肾损伤有两种不同的形式（先天性和后天性）。我们研究了与这两种情况相关的最新研究。
最近的文章主要集中在理解和可能的干预措施上，这些干预措施针对的是与反流相关的先天性和后天性肾脏异常。在先天性疾病中，特别关注的是尿路上皮和基因突变在正常和异常尿路发育中的重要性。至于尿路感染和肾脏瘢痕形成的易感性，尿调素在防止感染的防御机制中的重要性，以及在感染急性期通过维生素 A 和类固醇等手段减少瘢痕形成的干预措施的作用，都在文中进行了讨论。一篇特别有价值的最新文章表明，在儿童期尿路感染的女性中，在妊娠期间没有长期不良后果。
