Fifty-eight patients, three male and 55 female, with radiologically apparent renal scarring together with urinary tract infection have been followed for periods from five to 13 years. Control of urinary infection has been attempted by antibacterial treatment and prophylaxis, and radiological appearances, renal function and blood pressure have been monitored. Urinary infection was eliminated in 50 patients (86 per cent), all of whom became symptom-free. Evidence of new renal scarring was not seen, but three patients showed contraction of kidney size and three developed radio-opaque renal calculi. Vesico-ureteric reflux was demonstrated in 20 patients; surgical re-implantation of ureters was carried out in four patients and the indications for this operation are discussed. Of the 12 patients who had a raised serum creatinine at some time during the study only three showed progressive decline in renal function; the serum creatinine returned to normal in seven patients when infection was controlled. Hypertension was more common in patients with bilateral than in those with unilateral scarring, and all patients with evidence of impaired function at any time developed hypertension. We conclude that most patients with scarred kidneys and urinary infection can be rendered symptom-free by control of infection, and that there is some evidence that renal function can be preserved in this way.
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