The pathogenesis of reflux nephropathy.

In an experimental study, the scars of chronic pyelonephritis have been shown to be caused by infected intrarenal reflux. Intrarenal reflux occurs in the presence of vesicoureteric reflux and a renal papilla having special morphological characteristics predisposing to this phenomenon. Such papillae occur predominantly in the polar regions of the kidney where large pyelonephritic scars are most commonly seen. The clinical implications of this pathogenic mechanism are discussed.