Vesicoureteric reflux and renal injury.
Vesicoureteric reflux and renal injury.
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DOI：
10.1016/s0272-6386(12)80490-2
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发表时间：
1991-05
期刊：
影响因子：
--
通讯作者：
B. Arant
中科院分区：
文献类型：
--
作者：
B. Arant
与尿液肾内反流(IRR)相关的肾脏损伤是儿童和青春期严重高血压的主要原因，也是30岁以下患者慢性肾功能不全的主要原因。许多(但不是全部)青少年和成年反流性肾病(RN)患者在婴儿或儿童早期有尿路感染(UTI)或不明原因的发烧史，此时肾脏被认为是最有可能受到伤害的。尽管膀胱输尿管反流(VUR)在婴儿中比尿路感染儿童更常见，但在任何年龄的未感染患者中都很少见，永远不应被认为是人类发育过程中的正常发现。在发现输尿管返流后的许多年里，肾脏瘢痕可能在放射学或放射性核素研究中并不明显。当在几项研究中将手术矫正VUR与单纯的内科治疗进行比较时，无论VUR的级别如何，都没有观察到一种方法比另一种方法有明确的益处。此外，即使在输尿管反流得到纠正、感染被预防、高血压得到满意控制之后，仍可观察到疤痕肾脏的进行性肾损伤。局灶性肾小球硬化是一种在蛋白尿和RN患者中发现的病变，不仅在有疤痕的肾脏中被发现，而且在对侧无VUR的无疤痕肾脏中也可见，这可能提示一种体液因素或可能是一种高滤过现象。RN是儿童、青少年和年轻人中最常见的终末期肾病(ESRD)原因之一，这是潜在的可预防的。然而，预防将取决于及早发现有风险的患者--首次尿路感染后的婴儿和幼儿以及VUR患者的兄弟姐妹--积极有效地治疗尿路感染，最大限度地减少膀胱内压力，以及对患者、父母和医生进行教育。
Renal injury associated with the intrarenal reflux (IRR) of urine that is either infected, under high pressure, or both, is a major cause of severe hypertension during childhood and adolescence and of chronic renal insufficiency in patients less than 30 years of age. Many, but not all, adolescent and adult patients with reflux nephropathy (RN) give a history of urinary tract infection (UTI) or unexplained fevers in infancy or early childhood, when the kidney is thought to be at greatest risk of injury. Although vesicoureteric reflux (VUR) is observed more commonly in infants than children with UTI, it is rare in uninfected patients at any age and should never be considered a normal finding during human development. Renal scarring may not be obvious in radiographic or radionuclear studies for many years after the discovery of VUR. When surgical correction of VUR was compared in several studies to medical management alone, no definite benefit of one over the other was observed, regardless of the grade of VUR. Moreover, progressive renal injury in scarred kidneys has been noted even after VUR had been corrected, when infection had been prevented, and while hypertension had been controlled satisfactorily. Focal glomerular sclerosis, a lesion found in patients with proteinuria and RN, has been identified not only in scarred kidneys, but also may be seen in contralateral, unscarred kidneys without VUR, which might suggest a humoral factor or, perhaps, a hyperfiltration phenomenon. RN is one of the most frequent causes of end-stage renal disease (ESRD) in children, adolescents, and young adults, which is potentially preventable. However, prevention will depend on early identification of patients at risk—infants and young children after the first UTI and siblings of patients with VUR—aggressive and effective treatment of UTI, minimizing intravesical pressure, and education of patients, parents, and physicians.