@article{oai:niigata-u.repo.nii.ac.jp:00006544,
 author = {Tanizawa, Takakuni and Wada, Hiroyoshi and Shimada, Kenji and Ikoma, Fumihiko},
 journal = {Acta medica et biologica, Acta medica et biologica},
 month = {Mar},
 note = {To clarify the pathogenesis of reflux nephropathy (RN) leading to end-stage renal disease (ESRD), we investigated the clinicopathologic features of 20 children with RN and also compared urinary proteins in RN and primary focal glomerular sclerosis. The patients ranged from 3 months to 16 years of age at the time when kidney tissue was obtained, and included 15 boys and 5 girls. Imapired renal function (Ccr <70 ml/min 1.73 m^2) was observed in 10/12 patients with RN due to primary vesicoureteral reflux (VUR), and in 7/8 patients with RN due to secondary VUR. Light microscopy showed segmental glomerular sclerosis in 9/12 patients with RN due to primary VUR, and also moderate-to-severe tubulointerstitial changes. The onset of RN due to secondary VUR was earlier than that of RN due to primary VUR and the clinical outcome was worse. Most patients with secondary VUR and RN had more severe reflux and renal scarring than the primary VUR group. The main glomerular lesion in secondary VUR was globbal sclerosis, but tubuolointerstitial changes were similar to primary VUR. There was significant glomerular enlargement and Bowman's capsule area enlargement in RN with a Ccr< 70 ml/min 1.73m^2. In 14 RN patients, a significant negative corrilation was found between Ccr and quantitative tubulointerstitial changes (P <0.01). Proteinuria was chiefly albumin with a mixture of high and low molecular weight proteins. Since nephron mass reduction was evident when RN was diagnosed in almost all patients, subsequent loss of renal function appears inevitable, mainly due to hemodynamic overloading. To arrest progression to ESRD, early detection and management of RN is required by establishing a screening system for detecting urinary tract infection or VUR.},
 pages = {49--60},
 title = {Clinicopathologic Study of 20 Children with Reflux Nephropathy},
 volume = {40(Supplement)},
 year = {1992}
}