Reflux nephropathy from infancy to adolescence

Vesicoureteral reflux (VUR) has long been associated with febrile urinary tract infection (UTI), renal scarring, and chronic kidney disease. However, VUR is neither necessary nor sufficient for the development of renal scarring. The historical term reflux nephropathy (RN) encompasses a heterogeneous spectrum of renal abnormalities, including congenital renal dysplasia or hypodysplasia associated with VUR and acquired post-pyelonephritic renal scarring. These conditions may overlap and cannot always be reliably distinguished in an individual patient. The risk of renal damage is influenced by reflux grade, recurrent febrile UTI, intrarenal reflux, bladder and bowel dysfunction, pre-existing renal abnormalities, and individual host susceptibility. Contemporary management is therefore increasingly risk-based, with selective use of imaging and continuous antibiotic prophylaxis rather than uniform management based solely on VUR grade. Clinical presentation changes throughout life, ranging from febrile UTI or antenatally detected urinary tract abnormalities in infancy to hypertension, proteinuria, and impaired kidney function later in life. Most children with low-risk VUR do not develop progressive kidney damage. Long-term follow-up should therefore be individualized and focused on patients with bilateral or extensive renal damage, reduced kidney function, hypertension, or proteinuria. Structured transition to adult care is particularly important for adolescents with persistent risk factors or chronic kidney disease.