Intrarenal reflux and the scarred kidney

The incidence and significance of intrarenal reflux (pyelotubular backflow) occurring during micturating cystourethrography has been studied in 386 examinations on patients with vesicoureteric reflux. This phenomenon has not been observed in patients over the age of 4 years. Renal damage having the radiographic appearance of `atrophic pyelonephritic scarring' has been shown in 13 out of 20 kidneys showing intrarenal reflux. In 12 out of these 13 kidneys the damage corresponded exactly to those parts of the kidney in which intrarenal reflux had been evident. We suggest that severe degrees of vesicoureteric reflux and intrarenal reflux form the basis of renal scarring peculiar to `chronic atrophic pyelonephritis'.