Recurrent Urinary Infections in Girls

Pyelonephritis in Children

“…There seems to be little correlation between the number of recurrences and the effect after some years on the kidneys (Steele and others, 1963). The equal sex incidence of chronic pyelonephritis at autopsy in adults does not seem consistent with the much higher incidence of symptomatic infections in girls, suggesting that the one is not the direct antecedent of the other (Macaulay, 1964). However, some girls with recurrent infections have been observed to develop progressive loss of kidney parenchyma with a fatal issue (Williams, 1965).…”

“…A retrospective survey of a group of girls with recurrent urinary infections, previously investigated, failed to demonstrate any child in whom serious obstruction had been overlooked (Williams and Sturdy, 1961). But about 10%/, of affected girls show recurrence or persistence of infection, and a large proportion (variously estimated at 25% (Dunn and others, 1964), 50% (Spence and others, 1964) or 75% (Macaulay, 1964) have structurally normal urinary tracts. It is plain that damage from one attack confers in some way a susceptibility to further attacks (Lancet, 1963), and in experimental pyelonephritis intra-renal scarring permits of infection more readily, as also do areas of renal dysplasia (Kleeman and others, 1960).…”

“…In fact, the incidence among the newborn may be higher than in other age groups; congenital defects in the kidney may predispose (Porter and Giles, 1956). Postmortem studies suggest that the prevalence of urinary infection is still underestimated (Kleeman, Hewitt and Gaze, 1960); about 2%/, of routine autopsies on American children disclose evidence of pyelonephritis (Pryles and Neumann, 1962;Spark, Travis, Dodge, Dalschmer and Hopps, 1962;Macaulay, 1964), but the difficulties in diagnosis of this infection from postmortem material must be borne in mind. An increased incidence of pyelonephritis in siblings has been noted (Kunin, Deutscher and Paquin, 1964).…”

“…Of the chronic and recurrent groups the outcome varies, but the prognosis is believed to be worst when the onset is under two years of age. Some clear up, spontaneously (Kunin, Deutsches and Paquin, 1964) or with treatment (Turck, Browder, Lindmeyer, Brown, Anderson and Petersdorf, 1962;Macaulay, 1964) or at adolescence (Turner-Warwick, 1962;Williams, 1964). Others progress to renal failure (Rosenheim, 1963).…”

“…About ureteric reflux there is not yet sufficient evidence to justify invariable corrective surgery (Scott, 1962;TurnerAWarwick, 1962;Macaulay, 1964), nor has time enough elapsed to assess fully the results of corrective procedures (Johnston, 1963). Most surgeons advocate first a period of conservative management, with antibiotics and the use of "triple micturition" (Gross and others, 1963).…”