Treatment:

The degree of reflux is separated into five different grades. Simple or mild reflux often falls into grade I or II. How severe the reflux is and how much damage to the kidney is present helps determine treatment.

Simple, uncomplicated reflux (called primary reflux) less than grade III can be treated by the following:

• Antibiotics taken every day to prevent infections
• Careful watching
• Repeated urine cultures
• Yearly ultrasound of the kidneys

Controlling blood pressure is the most important measure to delay kidney damage. Therefore, the doctor may prescribe medicines to control high blood pressure. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) are used.

Surgical therapy is reserved for children who fail medical therapy.

More severe reflux may require surgery, especially in children who do not respond to medical therapy. Surgery to place the ureter(s) back into the bladder can be done to stop reflux nephropathy.

More severe reflux may require surgery, such as the following:

• Ureteral reimplantation
• Reconstructive repair

These surgeries result in less frequent and less severe urinary tract infections.

If needed, patients will be treated for chronic kidney disease.

Expectations (prognosis):

The outcome varies. Most cases of reflux nephropathy get better on their own. However, the damage to the kidney may be permanent. If only one kidney is involved, the other kidney may continue to function.

Reflux nephropathy may cause kidney failure in children and young adults.

Complications:

• Blockage of the ureter after surgery
• Chronic or repeat urinary tract infections
• Chronic renal failure if both kidneys are involved (can progress to end-stage kidney disease)
• Kidney infection
• High blood pressure
• Nephrotic syndrome
• Permanent damage to one or both kidneys
• Persistent reflux
• Scarring of the kidneys

Calling your health care provider:

Call your health care provider if you have symptoms of reflux nephropathy, or if you have decreased urine output or other new symptoms.