Reflux that leads to nephropathy must be chronic and is usually massive. Damage usually occurs during childhood, but changes are often not found until adulthood. Children usually present with recurrent urinary tract infections.
Parenchymal atrophy leads to broad-based scarring centered over the underlying calyx, which is clubbed (distorted calyx is called “clubbed”).
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| Gray scale ultrasound of kidney showing marked cortical thinning and irregularity from chronic pyelonephritis resulting in severe cortical loss (arrows). |
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| Contrast enhanced CT scan in patient with chronic reflux disease on right shows marked cortical thinning and irregularity (arrows) similar to the ultrasounds above and contrasted to normal left kidney (LK). |
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| Gray scale ultrasound of kidney showing normal upper pole parenchyma (*) which measures greater than 1cm but loss and thinning of lower pole parenchyma (arrows) in patient with chronic reflux disease resulting in lower pole cortical atrophy |
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