Pyelonephritis and Ascending Infection from the Lower Urinary Tract

Pyelonephritis in Children

“…Reflux occurs in man in congenital megaureter, in bladder wall abnormalities, with neurogenic lesions, with lower urinary obstruction, and with chronic pyelonephritis (Turner-Warwick, 1962; Gross and others, 1963;New England J. Med, 1963). It is also observed frequently in association with trigonitis and urethritis in young women as a transient phenomenon, and in this way probably disposes to ascending infection of the kidneys (Hanley, 1964). Its occurrence in obstructive uropathy is generally accounted for by the protrusion of a mucosal saccule at the ureteric orifice, while in non-obstructive urinary infections reflux is ascribed either to a congenital deficiency of ureteric muscle, to a shortened intramural course from a contracted bladder, or to rigidity from cedema of the bladder wall (Williams, 1964).…”

“…The follow-up in adults after 20 years can be appalling. In a survey relating to the pre-antibiotic era, 43%/0 of young women who had been treated for acute pyelonephritis had serious urological disease after 16 years (Hanley, 1964). There is not yet much information about the long-term prognosis for children.…”

Pyelonephritis lenta. Consideration of childhood urinary infection as the forerunner of renal insufficiency in later life.

“…It seems probable that reflux in unobstructed renal tracts should be looked upon as a congenital defect with a tendency to cease with increasing age (Spence et al, 1964;Hinman and Miller, 1964;Brueziere, 1965), a concept that is supported by a familial tendency to reflux, and a not uncommon association with renal malformation in sibs (MacGregor and Freeman, 1968). Except perhaps in the newborn (Laplane and Etienne, 1968), the concept of reflux as a temporary accompaniment of acute urinary infection (Hanley, 1964), at any rate in children, is losing ground.…”

“…'It is remarkable', they wrote, 'to what extent the insufficiency of renal function may advance in these patients without noticeable impairment in health of the individual.' Hanley (1964) reviewed 67 women who had had acute pyelonephritis 17 to 25 years previously. No less than 43% were found to have serious renal disease at follow-up 'as a result', Hanley writes, 'of acute pyelonephritis previously'.…”

“…Using the reverse approach, Kincaid-Smith et al (1964) found the incidence of pyelographic abnormality in bacteriuric women to be as high as 45%, and regarded pregnancy bacteriuria commonly as a manifestation of underlying chronic renal disease. Hanley (1965) considered acute-onchronic pyelonephritis in young women to be rather disastrous, and in a group of 88 women with acute pyelonephritis in pregnancy, mainly treated in hospital, 42% had serious renal damage 17 to 27 years later. Many had had trouble in childhood.…”