Vesicoureteral Reflux and Kidney Pain

Yes, vesicoureteral reflux can cause kidney pain, particularly in higher grades (IV-V) of reflux where renal damage is more likely to occur. 1

Pathophysiology of Pain in Vesicoureteral Reflux (VUR)

VUR allows urine to flow backward from the bladder into the ureters and kidneys, which can lead to kidney inflammation, infection, and subsequent pain 1
Higher grades of reflux (grades IV-V) are associated with greater risk of renal damage, with studies showing renal damage present in 47.9% of grade IV-V reflux cases 1
Fibrosis and scarring at the ureterovesical junction can cause narrowing of the ureteral lumen, leading to partial or complete obstruction of urine flow, which may manifest as flank or kidney pain 2
The combination of obstruction and infection significantly increases the risk of renal damage and associated pain 2

Flank pain is one of the most common presentations of VUR in adults 3
Pain may be associated with urinary tract infections (UTIs), which are common in patients with VUR 1
Renal cortical abnormalities (scarring) are more frequent in patients with VUR who have had previous UTIs, which can contribute to kidney pain 1
The presence of lower urinary tract dysfunction (LUTD) is an additional risk factor for renal damage and potential pain 1

Febrile UTIs, high-grade reflux, bilaterality, and cortical abnormalities are considered risk factors for renal damage 1
The estimate of renal damage in screened infants without infection is 21.8%, but this increases significantly with higher grades of reflux 1
Persistent obstruction from ureterovesical junction fibrosis can lead to renal cortical abnormalities and scarring 2
Renal scarring is associated with potential long-term complications including hypertension, growth impairment, and renal insufficiency, which may present with various symptoms including pain 2

Ultrasonography is recommended to assess the upper urinary tract for hydronephrosis and renal scarring in patients with suspected VUR and kidney pain 1, 2
DMSA renal imaging can be obtained to assess the status of the kidneys for scarring and function, particularly when there is concern for significant renal damage 1, 2
Symptoms indicative of bladder and bowel dysfunction (BBD) should be sought in the initial evaluation, as BBD is often associated with VUR and can influence outcomes 1

Treatment depends on the presence of a focal uptake defect on a radionuclide scan, clinical course, grade of reflux, ipsilateral renal function, bilaterality, bladder function, associated anomalies of the urinary tract, age, compliance, and parental preference 1
For high-risk patients (symptomatic patients with high-grade reflux, abnormal kidneys), surgical intervention should be considered 1
For moderate-risk patients, continuous antibiotic prophylaxis (CAP) is often the initial treatment, with intervention considered in cases of breakthrough infections or persistent VUR 1
Endoscopic management may include ureteral dilation, incision of strictures, or placement of ureteral stents for cases with obstruction causing pain 2

Regular ultrasonography is recommended every 12 months to monitor renal growth and any parenchymal scarring 2
DMSA imaging may be considered for follow-up to detect new renal scarring, especially after febrile UTIs 2
Serum creatinine should be monitored to assess renal function, particularly if bilateral renal cortical abnormalities are present 2

Not all patients with VUR will experience kidney pain; symptoms vary based on the grade of reflux, presence of infection, and extent of renal damage 1
Pain may be intermittent and associated with episodes of infection or obstruction 2, 3
In adults with VUR presenting with flank pain, surgical correction may be beneficial in preventing infection and associated pain 3
There is a sex difference in the development of reflux nephropathy: in most males, the kidneys are congenitally abnormal, while in females it is often an acquired condition related to recurrent UTIs 4