Skip to main content
Log in

Urinary infection, reflux and renal scarring in females continuously followed for 13–38 years

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

This study describes the pattern of urinary tract infections (UTI) in 87 females prospectively followed for a median of 23 years from their first recognized symptomatic infection in childhood. At 16 years of age they were selected for follow-up into adulthood because of renal scarring (reflux nephropathy) in 45 and recurrent UTI in 42. The attack rate (number of urinary tract infections per individual per observation year) was highest during the 1st year of life (1.9), with a gradual decrease to the lowest rate (0.2) at age 11–15 years. A moderately increased attack rate (0.4), was seen in the late teens, extending through to the mid twenties. The proportion of infections having a pyelonephritic character decreased with age and number of infection episodes, but not in females with severe renal scarring. Pyelonephritic infections were correlated with vesicoureteric reflux, and renal scarring to low age at the index infection, total number of pyelonephritic episodes and reflux. Females with renal scarring continued to have a high proportion of pyelonephritic recurrences after 10 years of age, implying that they risk progressive renal disease and should be closely followed into adulthood.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Kunin CM, Deutscher R, Paquin A (1964) Urinary tract infection in schoolchildren, an epidemiologic, clinical and laboratory study. Medicine (Baltimore) 43: 91–130

    Google Scholar 

  2. Winberg J, Andersen HJ, Bergström T, Jacobsson B, Larson H, Lincoln K (1974) Epidemiology of symptomatic urinary tract infection in childhood. Acta Paediatr Scand [Suppl] 252: 1–20

    Google Scholar 

  3. Lidin-Janson G, Jodal U, Lindberg U, Bergström T, Claesson I, Hanson LÅ, et al (1981) Aspects of urinary tract infections and renal scarring in girls entering adulthood. Contrib Nephrol 25: 17–22

    Google Scholar 

  4. Jodal U, Lindberg U, Lincoln K (1975) Level diagnosis of symptomatic urinary tract infections in childhood. Acta Paediatr Scand 64: 201–208

    Google Scholar 

  5. Hodson CJ, Wilson S (1965) Natural history of chronic pyelonephritic scarring. BMJ 2: 191–194

    Google Scholar 

  6. Smellie J, Edwards D, Hunter N, Normand ICS, Prescod N (1975) Vesico-ureteric reflux and renal scarring. Kidney Int 8: 65–72

    Google Scholar 

  7. International Reflux Study in Children (1985) International system of radiographic grading of vesicoureteric reflux. Pediatr Radiol 15: 105–109

    Google Scholar 

  8. Bradley JW (1968) Distribution-free statistical tests. Prentice-Hall, London, pp 68–86

    Google Scholar 

  9. Mantel N (1963) Chi-square tests with one degree of freedom; extensions of the Mantel-Haenszel procedure. J Am Stat Assoc 58: 690–700

    Google Scholar 

  10. Jodal U (1987) The natural history of bacteriuria in childhood. Infect Dis Clin North Am 1: 713–729

    Google Scholar 

  11. Stamey TA, Timothy M, Millar M, Mihara G (1971) Recurrent urinary infections in adult women. The role of introital enterobacteria. Calif Med 115: 1–19

    Google Scholar 

  12. Bollgren I, Winberg J (1976) The periurethral aerobic bacterial flora in healthy boys and girls. Acta Paediatr Scand 65: 74–80

    Google Scholar 

  13. Bollgren I, Winberg J (1976) The periurethral aerobic flora in girls highly susceptible to urinary infections. Acta Paediatr Scand 65: 81–87

    Google Scholar 

  14. Cox CE, Hinman F Jr (1961) Experiments with induced bacteriuria, vesical emptying and bacterial growth on the mechanism of bladder defence to infection. J Urol 86: 739–748

    Google Scholar 

  15. Hellström A, Hanson E, Hansson S, Hjälmås K, Jodal U (1991) Association between urinary symptoms at 7 years old and previous urinary tract infection. Arch Dis Child 66: 232

    Google Scholar 

  16. Martinell J, Jodal U, Lidin-Janson G (1990) Pregnancies in women with and without renal scarring after urinary infections in childhood. BMJ 300: 840–844

    Google Scholar 

  17. Hansson S, Jodal U, Norén L, Bjure J (1989) Untreated bacteriuria in asymptomatic girls with renal scarring. Pediatrics 84: 964–968

    Google Scholar 

  18. Hansson S, Jodal U, Lincoln K, Svanborg-Edén C (1989) Untreated asymptomatic bacteriuria in girls. II. Effect of phenoxyylpenicillin and erythromycin given for intercurrent infections. BMJ 298: 856–859

    Google Scholar 

  19. Pylkkänen J, Vilska J, Koskimies O (1981) The value of level diagnosis of childhood urinary tract infection in predicting renal injury. Acta Paediatr Scand 70: 879–883

    Google Scholar 

  20. Berg UB, Johansson SB (1983) Age as a main determinant of renal functional damage in urinary tract infection. Arch Dis Child 58: 963–969

    Google Scholar 

  21. Report of the International Reflux Study Committee (1981) Medical versus surgical treatment of primary vesicoureteral reflux: a prospective international reflux study in children. J Urol 125: 277–283

    Google Scholar 

  22. Jacobson S, Eklöf O, Lins L-E, Wikstad I, Winberg J (1992) Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood — a 27-year follow-up. Pediatr Nephrol 6: 19–24

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Martinell, J., Claesson, I., Lidin-Janson, G. et al. Urinary infection, reflux and renal scarring in females continuously followed for 13–38 years. Pediatr Nephrol 9, 131–136 (1995). https://doi.org/10.1007/BF00860724

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00860724

Key words

Navigation