Reflux nephropathy.

"Reflux nephropathy" has virtually replaced "chronic atrophic pyelonephritis" as the term used to cover a common disease characterised by renal scarring and recurrent urine infection and occurring particularly in children and women. The disease originates with vesicoureteric reflux in infancy, with scarring developing in the areas of kidney where intrarenal reflux occurs, owing to coincident maldevelopment of the usual valve-like orifices of papillary ducts. Urine infection plays an important role in both the pathogenesis of scars and the clinical picture of the disease, and is largely responsible for the preponderance of females diagnosed after the first year of life. The important features of management are detection and early treatment of urine infection and hypertension. With passage of time a complicating glomerular lesion, focal and segmental hyalinosis, and sclerosis develop in some patients and result in slow deterioration of renal function to end-stage renal failure over ten to 20 years. It is possible that low-protein diets may delay this process. With better understanding of the natural history of this disease there has been a swing to repair of reflux in only highly selected cases and an overall emphasis on medical management of this disease.