Reflux disease which cause proteinuria of nephrotic range

Ans. is 'b' i.e. Focal segmental glomerulosclerosis Vesicoureteric reflux is the retrograde flow of urine from bladder to the ureter and renal pelvis Q.The ureter is normally attached to the bladder in an oblique direction perforating the bladder muscle (detrusor) laterally, and proceeding between the bladder mucosa and detrusor muscle, creating a flap valve mechanism that prevents reflux.Reflux occurs when the submucosal tunnel between the mucosa and detrusor muscle is short or absentReflux predisposes to renal infection (pyelonephritis) by facilitating the transport of urine from bladder to the upper urinary tractThe inflammatory reaction caused by a pyelonephritic infection may result in renal injury or scarring also termed reflux nephropathy.Patients with pyelonephritis and reflux nephropathy who develop proteinuria in advanced stages exhibit secondary focal segmental glomerulosclerosis.Focal segmental glomerulosclerosisThis lesion is characterized by sclerosis of some but not all glomeruli (thus, it is focal) and in the affected glomeruli, only a portion of the capillary tuft is involved (thus it is segmental)It accounts for 10%-35% cases of nephrotic syndrome.Focal segmental glomerulosclerosis occurs in the following settings :In association with other known conditions such as. HIV infection (HIV nephropathy),Heroin addiction (heroin nephropathy)* Sickle cell disease . Massive obesityAs a secondary event, reflectingglomerular scarring in cases of focal glomerulonephritis.As a component of the adaptive response to loss of renal tissue (renal ablation, described earlier) in advanced stages of other renal disorders such asreflux nephropathy, hypertensive nephropathy or with unilateral renal agenesis.In certain inherited forms of nephrotic syndrome where the disease in some pedigrees has been linked to mutations in genes encoding nephrin, podocin or aactinin 4.As a primary disease (idiopathic focal segmental glomerulosclerosis)