Pyelonephritic scarring in 213 patients with upper and lower urinary tract infections: long-term followup.

Of 213 patients more than 3 years old with recurrent urinary tract infections new pyelonephritic scars formed only among those with a combination of urinary tract infection and vesicoureteral reflux. Of 61 patients with that combination new renal pyelonephritic scars developed in 7 (11.48 per cent) and severe clubbing in 2. Of 40 patients with vesicoureteral reflux who underwent an antireflux operation new scars formed in 5 and progressive renal damage occurred in 1. Most renal scars (58) were present at initial examination. Neither number of urinary tract infections, number of upper urinary tract infections localized by the bladder washout technique nor attacks of flank pain and fever were seen more often in patients who suffered new scars, and grade of reflux was not a factor. Patients in whom new scars developed during our prospective followup were younger than those who did not have new scars. However, new scars formed after an initial normal excretory urogram in only 1 patient with vesicoureteral reflux and urinary tract infection compared to 4 after an antireflux operation.