Children With Urinary Infection: A Comparison of Those With and Those Without Vesicoureteric Reflux

Abstract

Vesicoureteric reflux (VUR) is present in over one-third of the children investigated following urinary infection, and it is found in over 90% of the children with renal scarring of chronic atrophic pyelonephritis [1]. New scars have been observed to develop only when infection occurs in a urinary tract in which the vesicoureteric valve is incompetent [1, 2]. Such coarse renal scarring is one of the commonest causes of hypertension in children [3] and is present in over 25% of European children and young adults requiring dialysis or renal transplantation [4]. Apart from children with an obstruction to the outflow of urine (in whom the kidney is subjected to back pressure and is particularly vulnerable to infection), renal damage is most likely to be found among children with VUR. The early recognition of these susceptible children is obviously of the greatest importance. It is thought that VUR is generally present from birth and that deformity of the vesicoureteric junction with gross reflux may occasionally be part of a wider spectrum of congenital malformations of the urinary tract, though an aetiological role for infection has been proposed. Reflux may occur in more than one member of a family, and there are probably several modes of inheritance [5, 6]. Reflux tends to disappear with time. This has been observed in children [7–10]; it has been deduced in adults [11]; and it has been demonstrated in nonhuman primates [12]. In general, reflux is symptomless, and clinically the presence of VUR is usually unsuspected. Occasionally, in the older child or adult, transient loin pain may accompany micturition if there is marked reflux and the bladder has been allowed to become overdistended, with resulting distension of the renal pelvis. It may be suspected if residual urine is found on a second voiding within a few minutes of the first (double micturition). Because of the importance of early recognition of children with VUR and the lack of a noninvasive screening method for its detection, we have examined the clinical features of children presenting in hospital with urinary tract infection to determine whether there were any differences between those with and those without VUR.