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What is the cause and treatment for reflux nephropathy?

Q: My left kidney is small and contracted but the right kidney is fine. The left kidney is contracted due to the passage of urine from kidney to bladder and back. The doctor says that the stopper that stops the back flow of urine is there but since the bladder is big, it leads to the back flow of urine to the kidney. The doctor has performed systoscopy, IVP and ultrasound scan. I get repeated infection every year so the doctor says that I should get the kidney removed. Both the kidneys are fine. The problem began in childhood when I used to pass milky urine. After 23 years of age I started getting infection every year. Now I am 31 years old, married and have a daughter. Will I have a normal married life after the kidney removal? My BP is also on the higher side. The readings are 130/85 at home on an electronic machine and 140/90 or 150/90 at the clinic. The doctor has prescribed Aten-25. My ceretaine levels are normal. The details of the ultrasound, cyctoscopy and IVP reports are - Right kidney size: normal (9.1 x 3.9 cm); Left kidney size: small (5.8 x 2.0 cm). Renal echo pattern: normal and corticomedullary junction is well defined. Central echos: normal. No hyperechotic density could be demonstrated within the renal shadow. Renal capsular echo: normal & well defined. Urinary bladder: normal; no echogenic lesion. Prostatic image; normal. Impression - Left kidney: small in size; hypoplastic kidney; otherwise normal appearance. Right kidney & bladder: normal; No significant post void residue. Cystoscpy report of the small left kidney - Urethra: normal; Bladder grascystotic present. Right uretric: normal; Left uretric: Wide open and reflux present; No residual. Impression: vertico uretric reflex with CHR pyelonehritic atopatic kidney.

A:You have reflux nephropathy caused from chronic back leak of urine from bladder into ureters causing recurrent infections which have resulted in scarring of one of the kidneys. Each ureter has a one-way valve where it enters the bladder, preventing urine from flowing back up the ureter. Reflux nephropathy occurs when these valve-like mechanisms between the ureters and bladder fail, allowing urine to flow back up to the kidney. Reflux nephropathy may not produce any obvious signs. Reflux is often discovered when a child with repeat or suspect bladder infections is evaluated radiologically. Children with reflux nephropathy may be asymptomatic, they may present with nonspecific symptoms (e.g., failure to thrive, fever, poor food intake), they may be acutely ill in association with acute pyelonephritis, or they may present with renal failure with advanced renal scarring associated with reflux nephropathy. Although VUR occurs at a similar rate in boys and girls, girls are at greater risk of developing reflux nephropathy because of increased incidence of urinary tract infection (UTI). The most frequent complication of reflux nephropathy is urine infection. Other complications include high blood pressure, kidney stones, kidney pain and kidney failure. Treatment and prevention of urine infections is the most important treatment for reflux, and sometimes this requires long term antibiotic treatment. It is possible for a surgeon to perform an operation that is designed to reduce the reflux of urine. Since there already is evidence of scarring of one of the kidneys (which can not be reversed), steps must be taken to prevent further damage. If there is proven reflux and recurrent infection it may be advisable to remove that kidney. However, the BP should be controlled to <130/80. Moderate salt restriction and increased consumption of fresh fruits/vegetables is encouraged, smoking be quitted. Urine should be tested for proteinuria. Additionally, ACE inhibitors should be started to treat elevated BP and confer renoprotective effect. Since your creatinine is normal, removing diseased kidney will have no effect on the married life and sexual activity. However, kidney failure adversely effects libido and sexual activity.


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