Köhler J, Tencer J, Thysell H, Forsberg L
Department of Nephrology, Lund University Hospital, Sweden.
Nephrol Dial Transplant. 1997 Dec;12(12):2580-7. doi: 10.1093/ndt/12.12.2580.
To determine the incidence of urinary tract infections, hypertension, back pain, and renal calculi in adult patients with vesicoureteral reflux and reflux nephropathy.
A group of 115 patients (16-60 years of age, median 28 years) with vesicoureteral reflux, combined with reflux nephropathy in 101 patients, first detected between 1967 and 1984, was studied retrospectively. The group comprised 99 women and 16 men.
Symptoms and findings associated with the urinary tract preceded the diagnosis of vesicoureteral reflux by median 14 years (1-60 years). Intravenous pyelography preceded investigation with micturating cystography in 99 patients. Fifteen patients had no urinary tract infections, 17 patients had only lower urinary tract infections, and 83 patients had upper with or without lower urinary tract infections. Females had 12 times more lower and seven times more upper urinary tract infections than males, whereas males had impairment of renal function and proteinuria more often than females. Hypertension was present in 39 patients (34%) and five times more frequent in patients with bilateral than in those with unilateral reflux nephropathy. The median age at the first recording of hypertension was 33 years (16-60 years). Malignant hypertension was uncommon and occurred in two patients. An older group (> 45 years of age at presentation) of 19 patients showed a 90% incidence of hypertension compared with 23% in 96 patients in the younger group (< or = 45 years of age at presentation). Back pain of varying type and severity was present in 48 patients (42%). A total of 38 renal calculi was found in 21 (18%) patients, of whom 14 were completely asymptomatic.
The natural history of vesicoureteral reflux first detected in adulthood has shown a strikingly high incidence of urinary tract infections, arterial hypertension, back pain, and renal calculi.
确定成年膀胱输尿管反流及反流性肾病患者中尿路感染、高血压、背痛和肾结石的发生率。
对一组115例患者（年龄16 - 60岁，中位数28岁）进行回顾性研究，这些患者于1967年至1984年间首次被检测出患有膀胱输尿管反流，其中101例合并反流性肾病。该组包括99名女性和16名男性。
与泌尿系统相关的症状和体征在膀胱输尿管反流诊断之前出现的中位时间为14年（1 - 60年）。99例患者在进行排尿性膀胱造影检查之前先进行了静脉肾盂造影。15例患者无尿路感染，17例患者仅有下尿路感染，83例患者有上尿路感染，伴或不伴有下尿路感染。女性下尿路感染的发生率是男性的12倍，上尿路感染的发生率是男性的7倍，而男性肾功能损害和蛋白尿的发生率比女性更高。39例患者（34%）患有高血压，双侧反流性肾病患者高血压的发生率是单侧反流性肾病患者的5倍。首次记录到高血压的中位年龄为33岁（16 - 60岁）。恶性高血压并不常见，有2例患者出现。年龄较大组（就诊时年龄>45岁）的19例患者高血压发生率为90%，而年龄较小组（就诊时年龄≤45岁）的96例患者中高血压发生率为23%。48例患者（42%）出现不同类型和严重程度的背痛。21例（18%）患者共发现38颗肾结石，其中14颗完全无症状。
成年期首次检测出的膀胱输尿管反流的自然病史显示，尿路感染、动脉高血压、背痛和肾结石的发生率极高。
