On Controversial and Open Questions about the Course and Complications of Non‐Obstructive Urinary Tract Infection in Adult Women

Abstract

ABSTRACT. In an earlier report of the results of the initial medical examination in our population study from the period 1969–75 on non‐obstructive urinary tract infection (UTI) in non‐pregnant women, it was shown that the negative conclusions published by others on the importance of UTI and the value of early diagnosis rested on insecure grounds, owing partly to the test used in determination of renal function and partly to the selection of the material for the population studies. After, in most cases, long‐term treatment of 142 bacteriuric women there was significant improvement of the defective maximum urinary concentration ability, which continued until the end of the follow‐up period. There was no significant difference between the subgroups of women who had had and had not had symptomatic UTI in the past. 659 women were followed up for 36–80 months. They were divided into the same series as those to which they belonged initially in the earlier study: 1) 212 controls with no past history of subjective symptoms of upper or lower UTI and no urinary abnormalities, i.e. neither bacteriuria nor pyuria at the time of the first medical examination; 2) 180 women with a past history of symptomatic UTI but no urinary abnormalities; 3) 173 women with sterile pyuria; and 4) 94 women with bacteriuria/pyuria. About 40% of the women in the latter two series had no past history of UTI. In comparison with the other series, series 1 had a significantly lower number of women with symptomatic UTI and newly diagnosed hypertension during the follow‐up period as well as of women with bacteriuria and/or pyuria at the final examination. Between series 2, 3, and 4 there were significant differences mainly with respect to the final finding of pyuria; the number of such cases was highest in series 3. The importance of symptomatic UTI as a criterion is limited by the overlapping that is represented by the women in series 3 and 4 who had no past history of such symptoms at the time of the initial medical examination. Systematic radiological re examinations could not be carried out because of inadequate resources. The controversial question of a possible relation between non‐obstructive UTI and progressive renal damage in normotensive adult women is illustrated by the development of bilateral papillary necrosis and/or shrinking of the kidneys during a 6.1 (1–15) years' interval following the finding of a normal i.v. urogram in 33 selected patients aged 49.0 (26–71) who had a past history of UTI for 14.7 (2–40) years. Just over two thirds of them had had episodes of acute pyelonephritis. In two additional cases i.v. urography showed no abnormalities but renal angiography revealed parenchymal damage with scars. Furthermore, biopsy showed evidence of “chronic pyelonephritis” with an acute inflammatory process in a patient with normal urogram and normal angiogram. The reliability of radiographic methods and the possibility of demonstrating “progressive kidney damage” by i.v. urography in population studies with a relatively short follow‐up period are discussed. To what extent patients with UTI run the risk of progressive kidney damage of clinical importance still seems to be an open question.