title: Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up.
abstract: OBJECTIVE
  Determination of the long term incidence of uraemia, hypertension, and toxaemia in pregnancy associated with non-obstructive focal renal scarring after pyelonephritis in childhood 25-35 years earlier.
  
  
  METHODS
  27 Year follow up of patients with non-obstructive focal scarring identified from a retrospective review of intravenous urograms performed in childhood between 1951 and 1967.
  
  
  METHODS
  Paediatric primary referral centre and urological clinic in tertiary referral centre.
  
  
  METHODS
  30 Patients (mean age 33 (range 22-41] with non-obstructive focal renal scarring first detected between 1951 and 1967 and a history of febrile urinary tract infection.
  
  
  METHODS
  Hypertension and complications of renal damage.
  
  
  RESULTS
  Three patients had developed end stage renal disease, seven had developed hypertension, two of 16 women had a history of toxaemia during pregnancy, and seven patients had undergone renal surgery during follow up. Of the 20 patients who had neither had renal surgery nor had end stage renal disease, all had a significantly lower glomerular filtration rate and renal plasma flow and higher diastolic blood pressure, mean arterial blood pressure, plasma renin activity, and serum beta 2 microglobulin concentration than 13 healthy age matched controls. Diastolic blood pressure and plasma renin activity were positively correlated (r = 0.50, p less than 0.05) and so were fractional sodium excretion and both systolic and diastolic blood pressures (r = 0.54, p less than 0.01, r = 0.51, p less than 0.01 respectively). The progress of renal damage was unrelated to the incidence of recurrent infections.
  
  
  CONCLUSIONS
  Children with focal renal scarring due to pyelonephritis are at high risk of serious long term consequences. It is essential that they are given adequate attention and care during adolescence and pregnancy.
authors.affiliation: Karolinska Institute, Stockholm, Sweden.
authors.forename: S H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: O
authors.initials: O
authors.lastname: Eklöf
authors.forename: C G
authors.initials: CG
authors.lastname: Eriksson
authors.forename: L E
authors.initials: LE
authors.lastname: Lins
authors.forename: B
authors.initials: B
authors.lastname: Tidgren
authors.forename: J
authors.initials: J
authors.lastname: Winberg
mesh_terms: D000328:Adult; D001794:Blood Pressure; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000209:etiology*; D007668:Kidney / Q000503:physiopathology; D007676:Kidney Failure, Chronic / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011225:Pre-Eclampsia / Q000209:etiology; D011247:Pregnancy; D011379:Prognosis; D011704:Pyelonephritis / Q000150:complications* / Q000503:physiopathology; D012079:Renal Circulation; D012307:Risk Factors; D013997:Time Factors; D014511:Uremia / Q000209:etiology*