The long-term consequences of urinary tract infections: a historic and contemporary perspective.

Abstract

The long-term adverse consequences of UTI in childhood are hypertension, impaired renal function, end-stage renal disease, and complications during pregnancy. These adverse effects of UTIs are a result of renal parenchymal damage. Currently, these complications are unusual among patients in industrialized countries, unless kidney damage is present at birth. VUR, the most common abnormality encountered in infants and young children with UTIs, is not a diagnostic entity, but reflects a spectrum of underlying conditions. There may be nonobstructive VUR with no other urinary tract abnormality. VUR may be associated with voiding dysfunction and frequent UTIs. It may be present with bladder outlet obstruction, hydronephrosis, and intrauterine renal damage. Children with intrauterine renal damage are those most likely to develop hypertension and those at greatest risk for progression to end-stage renal disease. Acquired renal injury as a cause of adverse long-term consequences due to UTI is much less common than it was early in this century, probably as a result of improved health care.