Urinary tract infections per se do not cause end-stage kidney disease

The objective of this study was to determine the frequency with which urinary tract infection (UTI) in the absence of concomitant underlying abnormalities caused end-stage renal disease (ESRD). The records of 102 patients with ESRD (disease necessitating dialysis and/or transplant) seen at Children's Mercy Hospital during a 10-year period (1986- 1995) were reviewed. Obstructive uropathy, aplastic/hypoplastic/dysplastic kidneys, polycystic kidney disease, congenital nephrotic syndrome, acquired glomerulonephritis, idiopathic interstitial nephritis, hemolytic uremic syndrome, and a variety of systemic conditions were the cause of ESRD in 99 children; 3 children had reflux nephropathy, 1 of whom had no history of a UTI and another who had a single, afebrile UTI. A girl with a history of recurrent UTIs since 4 years of age had an elevated serum creatinine and grade II-III bilateral vesicoureteric reflux when evaluated at 8 years of age. She had ureteral reimplantations and control of the infections, but progressed to ESRD. This child appears to be the only 1 of 102 children who developed ESRD because of acquired renal injury in which UTIs were an important contributing factor.