The role of urinary tract infection in chronic renal failure.

The importance of bacterial infection as a major cause of progressive renal failure has become less prominent as long-term studies have failed to show progressive renal disease in bacteriuric humans. Functional or anatomic abnormalities of the urinary tract are necessary to perpetuate infection and cause renal scars and renal failure. In children, the most common abnormality is reflux. Sterile reflux that extends into the renal collecting ducts may cause scars previously called atrophic pyelonephritis. This entity is now referred to as reflux nephropathy. Other predisposing factors may lead to end-stage disease in a small proportion of bacteriuric patients. The most common are obstructive uropathy and calculus disease. Bacteriuria is difficult to eradicate in maintenance hemodialysis patients and may require bilateral nephrectomy. In transplant recipients, bacteriuria is common and has been associated with rejection and loss of allograft.