Reimplantation—Which Child?

  • J. J. Corkery
Part of the Clinical Practice in Urology book series (PRACTICE UROLOG)


The clinical and pathological significance of vesicoureteric reflux (VUR) lies mainly in its association with reflux nephropathy (RN). RN develops as a result of infection ascending from the urethra via the bladder and an incompetent ureterovesical valve to the renal pelvis; access to the renal parenchyma is via the collecting tubules. In the presence of intrarenal reflux (IRR) this access is greatly facilitated. There is both experimental (Ransley and Risdon 1978) and clinical (Rolleston et al. 1974) evidence to support the view that IRR is important in the pathogenesis of RN. It is particularly noteworthy that the scars of RN occur predominantly in those parts of the kidney where compound refluxing papillae are usually found. Furthermore, it is common clinical experience that new scars are rarely seen to develop in children over the age of 5 years, the age beyond which IRR is not seen (Rolleston et al. 1974). This would seem to imply that once the “at risk” refluxing papillae have been damaged by the initial infection the remainder of that kidney is at very low risk of being scarred by further infection, even in the presence of persistent VUR.


Vesicoureteric Reflux Renal Scarring Acute Pyelonephritis Urologic Surgery Asymptomatic Bacteriuria 
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© Springer-Verlag Berlin Heidelberg 1988

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  • J. J. Corkery

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