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Prof. Dr. Ali Avanoğlu
Vesicoureteral Reflux (VUR) • Kidney health and infection

Does VUR Cause Kidney Failure? Blood Pressure, Proteinuria, and Function

The deepest worry for families of children with kidney reflux (vesicoureteral reflux, VUR) is kidney failure. The truth is this: reflux itself does not cause kidney failure; the long-term risk is limited to the small number of children with extensive scarring in both kidneys, and even in these children, blood pressure and kidney function can be preserved for years with regular follow-up. This page explains how hypertension, proteinuria, and kidney function are monitored.

Who this is forFamilies of children found to have renal scarring; adolescent and adult reflux patients
Reading≈6 min
ByProf. Dr. Ali AvanoğluUpdated
This page is part of vesicoureteral reflux.Read the full treatment overview on the hub page
RIGHT%62RELATIVE FUNCTIONLEFT%38RELATIVE FUNCTIONDashed rings: multiple scarred areas
DMSA: multiple scars
01 · The short answer: no, in most children02 · How does scarring raise blood pressure?03 · Proteinuria: an early warning sign04 · Kidney function and end-stage kidney failure05 · How is follow-up carried out?06 · Nephrology collaboration and transition to adulthood
In brief5 madde
  • The short answer: no, in most children: In the large majority of children with kidney reflux, kidney function remains normal for life.
  • How does scarring raise blood pressure?: Scarred kidney tissue can sense reduced blood flow and respond by releasing more of the hormones (the renin system) that raise blood pressure.
  • Proteinuria: an early warning sign: Protein leaking into the urine (proteinuria) is an early sign that the remaining healthy kidney tissue is starting to be overloaded.
  • Kidney function and end-stage kidney failure: Kidney function is monitored with blood creatinine measurement and the filtration rate calculated from it (GFR; using a formula based on height and creatinine).
  • How is follow-up carried out?: For a child found to have scarring, or with high-grade bilateral reflux, the follow-up plan includes the following elements…
01

The short answer: no, in most children

In the large majority of children with kidney reflux, kidney function remains normal for life. The risk of kidney failure depends less on the grade of reflux and more on how much healthy tissue remains in the kidney.

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  • In older case series, reflux nephropathy was one of the leading causes of childhood kidney failure. As early diagnosis, prompt treatment of febrile infection, and regular follow-up became more widespread, that share fell markedly; today, end-stage kidney failure caused by reflux nephropathy is seen mainly in children with severe bilateral scarring, most often on a background of congenital dysplasia.
  • That is why our answer to families asking “does reflux cause kidney failure?” is individualized: if there is no scarring on DMSA, or only a limited one-sided scar, the risk is close to that of the general population; if there is extensive bilateral scarring and reduced kidney function, close follow-up and collaboration with nephrology are needed.
02

How does scarring raise blood pressure?

Scarred kidney tissue can sense reduced blood flow and respond by releasing more of the hormones (the renin system) that raise blood pressure. Over the years, this mechanism can lead to hypertension, most often during adolescence and young adulthood.

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  • In the literature, the long-term rate of hypertension in individuals with scarring — especially bilateral reflux nephropathy — has been reported at roughly 10–20%; in reflux patients without scarring, this risk is close to that of the general population. Rates vary by series, by how extensive the scarring is, and by length of follow-up.
  • Hypertension causes no symptoms in children; headache or nosebleeds are late and unreliable signs. That is why the cornerstone of follow-up is blood pressure measured at every visit with a cuff appropriate for the child's age and height. Borderline or elevated readings are confirmed with 24-hour blood pressure monitoring (ambulatory measurement). Hypertension caught early responds well to medication and protects the kidney.
03

Proteinuria: an early warning sign

Protein leaking into the urine (proteinuria) is an early sign that the remaining healthy kidney tissue is starting to be overloaded. The appearance of proteinuria in a scarred kidney indicates an increased risk of function loss in later years.

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  • For this reason, every child with scarring has a yearly urinalysis; when needed, a first-morning urine protein/creatinine ratio or a microalbumin measurement is added. Temporary proteinuria can occur after a febrile illness or intense exercise; persistence is confirmed by repeat measurement.
  • If persistent proteinuria is found, the child is evaluated jointly with pediatric nephrology. At this stage, kidney-protective medications (the drug class that suppresses the renin system) both lower blood pressure and reduce protein leakage, slowing the loss of function.
04

Kidney function and end-stage kidney failure

Kidney function is monitored with blood creatinine measurement and the filtration rate calculated from it (GFR; using a formula based on height and creatinine). While DMSA's split function shows each kidney's relative contribution, GFR measures total function — the two complement each other.

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  • End-stage kidney failure due to reflux nephropathy is rare today and occurs almost exclusively in individuals with extensive bilateral scarring whose function was already reduced when followed in childhood. In a child with one-sided scarring whose opposite kidney is healthy, total function remains normal.
  • Even in the small number of children who do lose function, the course is usually slow; blood pressure control, treatment of proteinuria, infection prevention, and nephrology follow-up can extend this process for years. We take care to explain this picture to families honestly — without exaggerating it, but without hiding it either.
05

How is follow-up carried out?

For a child found to have scarring, or with high-grade bilateral reflux, the follow-up plan includes the following elements (frequency varies with the extent of scarring and by center):

  • Blood pressure measurement with an appropriately sized cuff at every visit; at least once a year, with 24-hour monitoring for borderline readings
  • Urinalysis once a year; protein/creatinine ratio if needed
  • Kidney–bladder ultrasound once a year: kidney size, growth, and thickness
  • Periodic blood creatinine and GFR calculation in scarred and bilateral cases
  • A follow-up DMSA at 4–6 months after any new febrile infection (to check for new scarring)
  • Monitoring of height and weight; a plateau in growth can be an early sign of function loss
  • Reassessment during adolescence and a planned transition to adult follow-up
06

Nephrology collaboration and transition to adulthood

Managing the reflux and the infections is the job of pediatric urology, while monitoring blood pressure, proteinuria, and kidney function is carried out jointly with pediatric nephrology. For a child with scarring, a follow-up arrangement is set up in which the two specialties stay in contact with each other and share test results.

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  • Although reflux has resolved by adolescence in most children, the scar remains; the risk of hypertension and proteinuria then emerges in adulthood. Follow-up therefore does not end once the reflux has resolved — for a person with scarring, it carries over into adult life. Pre-pregnancy counseling for female patients is a natural part of this follow-up; the risk in pregnancy relates less to the reflux itself than to the scarring and kidney function.
  • In our practice, pediatric urology and adult urology work side by side; follow-up that begins in childhood continues with the same team through adolescence and adulthood, together with nephrology when needed.
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Frequently asked questions
My child's reflux has resolved — is blood pressure follow-up still needed?
If there is no scarring on DMSA, routine follow-up usually steps down to the level of general pediatric health checks. If there is scarring, yearly blood pressure and urine follow-up continues even after the reflux has resolved, because the risk of hypertension is tied to the scar, not the reflux, and can appear years later.
There's a scar in one kidney and the other is healthy — will kidney failure develop?
A healthy opposite kidney largely preserves total function; kidney failure is not expected with one-sided scarring. Blood pressure and urine follow-up are still recommended, though, because even a one-sided scar can, in a small proportion of cases, lead to hypertension.
What does GFR mean, and when is it measured?
GFR is the rate at which the kidneys filter the blood; in children it is calculated from height and blood creatinine. It is not routinely needed in reflux without scarring; it is measured periodically in children with bilateral or extensive scarring, and in those reported to have reduced function on DMSA.
If blood pressure turns out to be high, does kidney transplantation come into the picture?
No; hypertension does not mean kidney failure. Hypertension caught early is brought under control with medication, and that control protects the kidney. Transplantation can only come into consideration in the rare cases of advanced function loss due to severe bilateral scarring, and only after years of follow-up.
←Previous • Kidney health and infectionIs Kidney Reflux Dangerous? Reflux Nephropathy and Renal ScarringNext • Kidney health and infectionUrinary Tract Infection Symptoms in Children→
Related pagesFull index →
Kidney health and infectionIs Kidney Reflux Dangerous? Reflux Nephropathy and Renal ScarringThe honest answer to “is kidney reflux dangerous?” has two sides: reflux itself is harmless and temporary in most children; what truly matters is whether permanent kidney damage — reflux nephropathy, renal scarring — develops alongside a febrile infection. This page explains what scarring is, its two different types, how it is detected with DMSA, which children are at higher risk, and what can be prevented.After treatment and follow-upLong-Term Follow-up in VUR: Ultrasound, Blood Pressure, Urine, and Discharge from Follow-upEven after vesicoureteral reflux (VUR) has resolved on its own, or been treated with injection or surgery, follow-up continues for a while longer, because what really needs protecting is the kidney tissue itself. This page explains what is checked at the yearly visit, when DMSA is needed, when follow-up can be ended, and counseling during adolescence and pregnancy.By age and special situationsVUR in Adolescents and Adults: Follow-up and PregnancyVesicoureteral reflux (VUR) that carries into adolescence and adulthood is most often low-grade and silent; but follow-up does not end here — it changes form. On this page we explain reflux that has not closed by adolescence, VUR in adults, and what infection–hypertension risk in pregnancy actually depends on.Diagnosis and evaluationDMSA Renal Scan: Scarring and FunctionThe DMSA renal scan is the test that shows whether vesicoureteral reflux (VUR) has damaged the kidney: it reveals both the areas affected by kidney infection (pyelonephritis) and permanent marks (scarring), as well as each kidney's contribution to overall function (split function). This page explains when and why a DMSA is done, how it's performed, and how to read the result.
Vesicoureteral Reflux (VUR) topic clustersMain treatment page →
Basics 6Diagnosis and evaluation 6By age and special situations 5Bladder and bowel 5Treatment pathways 10Kidney health and infection 5After treatment and follow-up 6
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