A Study of Fifty-eight Patients with Renal Scarring Associated with Urinary Tract Infection

Fifty-eight patients, three male and 55 female, with radiologicallyapparent renal scarring together with urinary tract infectionhave been followed for periods from five to 13 years. Controlof urinary infection has been attempted by antibacterial treatmentand prophylaxis, and radiological appearances, renal functionand blood pressure have been monitored. Urinary infection waseliminated in 50 patients (86 per cent), all of whom becamesymptom-free. Evidence of new renal scarring was not seen, butthree patients showed contraction of kidney size and three developedradio-opaque renal calculi. Vesico-ureteric reflux was demonstratedin 20 patients; surgical re-implantation of ureters was carriedout in four patients and the indications for this operationare discussed. Of the 12 patients who had a raised serum creatinineat some time during the study only three showed progressivedecline in renal function; the serum creatinine returned tonormal in seven patients when infection was controlled. Hypertensionwas more common in patients with bilateral than in those withunilateral scarring, and all patients with evidence of impairedfunction at any time developed hypertension. We conclude thatmost patients with scarred kidneys and urinary infection canbe rendered symptom-free by control of infection, and that thereis some evidence that renal function can be preserved in thisway.