Editing Pediatrics: Vesicoureteral Reflux (section)

== Complications of Acquired Scarring ==

* '''<span style="color:#ff0000">Hypertension'''
** '''Severity of reflux nephropathy in children is associated with progression to hypertension'''
*** '''Reflux nephropathy is the most common cause of severe hypertension in children and young adults'''
*** Remains unclear whether it is the nephropathy associated with postinfection scarring, congenital dysmorphism associated with reflux, or some combination of both that predisposes to hypertension
** '''Successful correction of reflux alone is unlikely to ameliorate blood pressure'''
*** '''Removal of renal segments verified by selective renal vein sampling of arteriolar or segmental vessel renin levels has provided durable normalization of blood pressure in carefully selected patients'''
*** On occasion, complete removal of a small unilateral congenitally dysmorphic or globally scarred and shrunken kidney also may correct renovascular hypertension
* '''<span style="color:#ff0000">Renal Growth'''
** Factors contributing to the effects of reflux on renal growth:
**# Congenital dysmorphism often associated with, but not caused by, reflux
**# Number and type of urinary infections and their resultant nephropathy
**# Grade of reflux in the affected kidney
**# Quality of the contralateral kidney and its implications for compensatory hypertrophy
**#* Compensatory hypertrophy of the contralateral kidney will magnify the perceived impact of infection on renal growth because the contralateral developing kidney will assume the required renal function whenever the ipsilateral kidney is unable to contribute optimally to function.
* '''<span style="color:#ff0000">Renal Failure'''
** The '''medical renal disease that accompanies renal scarring''' can include hyperfiltration, concentrating defects, proteinuria, microalbuminuria, renal tubular acidosis, and increased fractional excretion of sodium and magnesium.
* '''<span style="color:#ff0000">Somatic Growth'''
** '''An accurate reflection of renal cortical integrity'''
*** Many children with VUR fall below the normal age-adjusted growth curve, particularly in patients with bilateral reflux and some degree of renal damage.
*** Successful suppression of pyelonephritis through either medical prevention of infection or surgical correction of reflux itself can result in catch-up growth, both for height and weight