Pediatrics: Vesicoureteral Reflux: Difference between revisions
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== Complications of Acquired Scarring == | == Complications of Acquired Scarring == | ||
* '''Hypertension''' | * '''<span style="color:#ff0000">Hypertension''' | ||
** '''Severity of reflux nephropathy in children is associated with progression to 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''' | *** '''Reflux nephropathy is the most common cause of severe hypertension in children and young adults''' | ||
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*** '''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''' | *** '''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 | *** On occasion, complete removal of a small unilateral congenitally dysmorphic or globally scarred and shrunken kidney also may correct renovascular hypertension | ||
* '''Renal Growth''' | * '''<span style="color:#ff0000">Renal Growth''' | ||
** Factors contributing to the effects of reflux on renal growth: | ** Factors contributing to the effects of reflux on renal growth: | ||
**# Congenital dysmorphism often associated with, but not caused by, reflux | **# Congenital dysmorphism often associated with, but not caused by, reflux | ||
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**# Quality of the contralateral kidney and its implications for compensatory hypertrophy | **# 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. | **#* 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. | ||
* '''Renal Failure''' | * '''<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. | ** 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. | ||
* '''Somatic Growth''' | * '''<span style="color:#ff0000">Somatic Growth''' | ||
** '''An accurate reflection of renal cortical integrity''' | ** '''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. | *** Many children with VUR fall below the normal age-adjusted growth curve, particularly in patients with bilateral reflux and some degree of renal damage. | ||