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Intra-renal reflux
  1. S Kanumakala,
  2. V Kalidasan,
  3. I Kenney
  1. Royal Alexandra Hospital, Brighton, UK;

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    Intra-renal reflux may accompany high-grade vesico-ureteral reflux (VUR) and represents the severe end of the VUR spectrum. In addition, intra-renal reflux is usually seen in very young patients. Presence of intra-renal reflux is a high risk factor for renal scarring, which is an important cause of chronic renal failure and arterial hypertension in children.1 When Angulo et al investigated VUR, they documented intra-renal reflux in 17/89 kidney units in 61 patients with VUR.2

    Voiding cysto-urethrography remains the gold standard for the diagnosis of VUR3 and is one of the best modalities to demonstrate intra-renal reflux, if present. This is often seen as a wedge or fan shaped flush of contrast starting from the calyces outlining the renal papillae, and may extend to the surface of the kidney (see fig 1).

    Early recognition of VUR and prompt management favourably influences the prognosis4,5 and hence all children at risk should be screened.6 In particular, children with intra-renal reflux should be considered for early intervention to stop reflux (either by endoscopic correction or ureteric implantation) and have regular follow up to monitor renal growth and renal function.

    Figure 1

     Arrows show the presence of intra-renal reflux.