Vesicoureteric reflux and reflux nephropathy: The Christchurch contribution

For the past 40 years members from the Christchurch departments of paediatrics, nephrology, radiology, pathology and nuclear medicine have studied the entity of vesicoureteric reflux and its main complication of reflux nephropathy. Initially the natural history of vesicoureteric reflux was examined by investigating 350 infants with urinary infection by intravenous urography and micturating cystourethrography. The 40% demonstrating reflux were followed up for approximately 12 years. This study showed that infancy and early childhood were the critical periods for renal damage to occur, that the damage was confined to those kidneys subjected to severe degrees of reflux, that lesser degrees of reflux were not associated with renal damage and that a spontaneous lessening of the severity of reflux occurred with increasing age. Other aspects of reflux nephropathy also have been studied including pathogenic mechanisms resulting in renal damage, ultrasonography to examine fetal anatomy, radioisotopic methods for demonstrating renal scarring and reflux, and the long term follow up of adults with reflux nephropathy.