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PubMed1995

Screening and treatment of asymptomatic bacteriuria of pregnancy to prevent pyelonephritis: a cost-effectiveness and cost-benefit analysis.

OBJECTIVE: To compare the effectiveness, benefits, and costs of two asymptomatic bacteriuria screening and treatment strategies to prevent pyelonephritis in pregnancy. METHODS: A decision analytic model was created to compare strategies based on either 1) a leukocyte esterase-nitrite dipstick, or 2) on urine culture, with a policy of no screening or treatment. A literature search was conducted to generate probability estimates. Cost estimates were based on a local pharmacy and laboratory survey and supplemented by recent literature estimates. Sensitivity analyses were performed over wide ranges of probability and cost estimates. RESULTS: Under baseline assumptions, no screening resulted in 23.2 cases of pyelonephritis per 1000 pregnancies, versus 16.2 cases with the dipstick strategy and 11.2 with the culture strategy. The cost of screening and treatment of asymptomatic bacteriuria per 1000 pregnancies was $1968 with dipstick and $19,264 with culture. The cost of treating pyelonephritis with no screening was $57,562, versus $40,257 with dipstick and $27,832 with culture. Therefore, both the dipstick strategy and the culture strategy were cost-beneficial (based on a pyelonephritis cost of $2485) when compared with no screening. However, because it cost $3492 to prevent each additional case of pyelonephritis with culture that was not prevented by dipstick, the culture strategy was not cost-beneficial compared with the dipstick strategy. These results were sensitive to varying estimates for the prevalence of asymptomatic bacteriuria, the rate of progression of asymptomatic bacteriuria to pyelonephritis, the sensitivity of the dipstick, culture costs, and the cost of a case of pyelonephritis. CONCLUSION: When compared with a policy of no screening, screening for and treatment of asymptomatic bacteriuria to prevent pyelonephritis in pregnancy is cost-beneficial whether based on the leukocyte esterase-nitrite dipstick or on urine culture. However, the culture strategy is not cost-beneficial when compared with the dipstick strategy.

Bacteriological Techniques↗

PubMed1988

Pyelonephritis in adult women: inpatient versus outpatient therapy.

PURPOSE: The traditional treatment of acute pyelonephritis has been hospitalization and parenteral administration of antibiotics. No previous study, however, has attempted to differentiate between those patients with pyelonephritis who might be safely managed as outpatients and those in whom hospitalization is required. We therefore decided to determine whether women with pyelonephritis can be effectively and safely managed outside the hospital. PATIENTS AND METHODS: The medical records of 94 female outpatients and 100 hospitalized women treated for acute pyelonephritis at San Francisco General Hospital were reviewed. Utilizing baseline clinical and laboratory data, we compared outcome in the two groups, and computed the cost-benefit of managing pyelonephritis on an outpatient basis. RESULTS: We observed a similarity in the frequency of successful outcomes (approximately 90 percent in each group) and absence of serious adverse outcome in any outpatient. Results of urine culture were comparable in inpatients and outpatients, with Escherichia coli identified as the most common urinary pathogen in both groups. The frequency of resistance to ampicillin of E. coli and other urinary pathogens was nearly 30 percent. A cost analysis demonstrated a 7.5-fold difference between the inpatient and outpatient groups. CONCLUSION: Our findings suggest that treatment of pyelonephritis with oral antibiotics poses a safe and effective method of therapy in immunocompetent women without underlying illness. The use of ampicillin as a single agent for the treatment of pyelonephritis, however, is inadvisable. Our study also demonstrates the potential savings in managing selected patients with pyelonephritis as outpatients.

Acute Disease↗

PubMed1992

Dimercaptosuccinic acid renal scintigraphy for the evaluation of pyelonephritis and scarring: a review of experimental and clinical studies.

Renal cortical scintigraphy has been reported to be useful in children for confirmation of the diagnosis of acute pyelonephritis. Subsequent experimental studies have demonstrated that dimercaptosuccinic acid (DMSA) scintigraphy, when compared directly with histopathology, is highly reliable for the detection and localization of parenchymal inflammatory changes associated with acute pyelonephritis. Recent clinical studies of acute pyelonephritis using DMSA scintigraphy reveal that the majority (50 to 91%) of children with febrile urinary tract infections have abnormal DMSA renal scan findings and that the majority of these children do not have demonstrable vesicoureteral reflux. However, when vesicoureteral reflux is present, renal cortical abnormalities are demonstrated by DMSA scintigraphy in 79 to 86% of the kidneys. In children with febrile urinary tract infections routine clinical and laboratory parameters are not reliable in the differentiation of acute pyelonephritis, documented by DMSA renal scan findings, from urinary tract infections without parenchymal involvement. Furthermore, the presence of P-fimbriated Escherichia coli associated with febrile urinary tract infections does not reliably predict those kidneys that have acute parenchymal inflammation demonstrated by DMSA renal scans. DMSA is also the isotope agent of choice for the detection of renal scarring. Clinical studies report greater sensitivity of DMSA renal scintigraphy for the detection of renal scarring when compared with the excretory urogram, particularly in infants and young children. In a recent prospective study of post-pyelonephritic renal scarring in children we found that acquired renal scarring only occurs in sites corresponding exactly to previous areas of acute pyelonephritis demonstrated by DMSA scintigraphy at the time of infection. Furthermore, once acute pyelonephritis occurs, ultimate renal scarring is independent of the presence or absence of vesicoureteral reflux. These findings provide convincing evidence that renal parenchymal infection, rather than vesicoureteral reflux, is the prerequisite for acquired (postnatal) renal scarring. Vesicoureteral reflux as a risk factor for acquired renal scarring is directly related to its role as a risk factor for acute pyelonephritis. We conclude that DMSA scintigraphy is a valid tool for confirming the diagnosis of acute pyelonephritis in children and for identifying kidneys at risk for subsequent renal scarring.

Acute Disease↗

PubMed1997

Soluble receptors to tumour necrosis factor and interleukin-6 in urine during acute pyelonephritis.

We compared the urinary concentrations of soluble TNF-I (sTNF-RI), TNF-II receptors, and soluble IL-6 receptor (sIL-6R) standardized to urinary creatinine concentrations, in children with acute pyelonephritis, in children with non-renal fever and in healthy controls. These levels were related to the acute inflammatory response in the kidneys and later renal scarring, as determined by acute and 1-y follow-up with 99mTC-dimercaptosuccinic acid scintigraphy (DMSA). The concentrations of the soluble receptors were measured using enzyme immunoassay (EIA). The urinary levels of sTNF-RI were significantly higher in children with acute pyelonephritis (median 1320 pg/mmol) than in children with non-renal fever, children 6 weeks after acute pyelonephritis and healthy controls (873, 251 and 477 pg/mumol, respectively). Median sTNF-RII urine levels were also higher in acute pyelonephritis (4123 pg/mumol) than in the three control groups (2000, 964 and 1850 pg/mumol, respectively). In contrast, the highest urinary sIL-6R concentrations were found in healthy children (median 420 pg/mumol), compared to those with acute pyelonephritis (235 pg/mumol), children with non-renal fever and children 6 weeks after pyelonephritis (137 and 50 pg/mumol, respectively). No significant difference was found in any of the urinary soluble receptor levels in children with or without DMSA uptake defects at the acute or the 1-y follow-up scintigraphy. In conclusion, although the urinary soluble TNF receptor levels were higher during acute pyelonephritis, this observation was not useful for deciding which children needed follow-up after acute pyelonephritis.

Acute Disease↗

PubMed1998

Comparison of Escherichia coli strains recovered from human cystitis and pyelonephritis infections in transurethrally challenged mice.

Urinary tract infection, most frequently caused by Escherichia coli, is one of the most common bacterial infections in humans. A vast amount of literature regarding the mechanisms through which E. coli induces pyelonephritis has accumulated. Although cystitis accounts for 95% of visits to physicians for symptoms of urinary tract infections, few in vivo studies have investigated possible differences between E. coli recovered from patients with clinical symptoms of cystitis and that from patients with symptoms of pyelonephritis. Epidemiological studies indicate that cystitis-associated strains appear to differ from pyelonephritis-associated strains in elaboration of some putative virulence factors. With transurethrally challenged mice we studied possible differences using three each of the most virulent pyelonephritis and cystitis E. coli strains in our collection. The results indicate that cystitis strains colonize the bladder more rapidly than do pyelonephritis strains, while the rates of kidney colonization are similar. Cystitis strains colonize the bladder in higher numbers, induce more pronounced histologic changes in the bladder, and are more rapidly eliminated from the mouse urinary tract than pyelonephritis strains. These results provide evidence that cystitis strains differ from pyelonephritis strains in this model, that this model is useful for the study of the uropathogenicity of cystitis strains, and that it would be unwise to use pyelonephritis strains to study putative virulence factors important in the development of cystitis.

Animals↗

PubMed1987

[Prevention of acute and recurrent pyelonephritis in pregnancy].

In recent years the morbidity of the acute gestational pyelonephritis increased nearly double. From the anamnesis of 234 female patients who were hospitalised on account of chronic pyelonephritis or urolithiasis in 34.9% renal complications during pregnancy could be established. In these cases a sixfold increased coincidence of the lateral localisation of urological disease compared with the lateral localisation of the obstetrical complications. From the catamnestic data of 32 patients resulted a pathogenetic connection between chronic urological disease and acute gestational pyelonephritis. Pregnant women with contracted pelvis, megafetus, multigravidity and hydramnion fell ill from acute pyelonephritis 4 to 6 times more frequently than those in whom these risk factors which we intend to call compression factors were not existing. 72 pregnant women with compression factors and asymptomatic bacteriuria were given prophylactically antibiotics and carried out position exercises. In none of these pregnant women an acute pyelonephritis appeared during pregnancy. Apart from the primary prevention of the acute gestational pyelonephritis in 108 pregnant women also a prophylaxis of the recidivation of pyelonephritis has been performed. This consisted of a therapy with antibiotics for the persisting, asymptomatic bacteriuria as well as position exercises. Only in 2.7% of the metaphylactically cared patients a recidivation of the acute gestational pyelonephritis developed. Thus incomparison to other authors the number of recidivations of acute gestational pyelonephritides could bei reduced by the four- to sixfold.

Acute Disease↗

PubMed1979

[The pathogenesis of chronic pyelonephritis and its therapeutic consequences].

During the last 2 years we examined 186 patients with secondary and 42 patients with primary chronic pyelonephritis. In most cases the secondary pyelonephritis is the sequel of a urolithiasis, less frequently in congenital renal anomalies, adenomas of the prostatic gland and patients with superposed pyelonephritis in renal lesion on account of metabolic disturbances (diabetes, gout) or abuse of analgetics. The course of the disease as well as the results of the therapy show peculiarities in the two forms of pyelonephritis. Thus, for example, the recidivations are more frequently in the secondary pyelonephritis, in the urine culture other germs appear more frequently, and the disease shows a more rapid course. The bacterial sanation in patients with primary pyelonephritis remains stable in the course of one year, where as in the obstructive pyelonephritis (non-operated cases) in the same period all patients show recidivations. After operative treatment of the obstruction the conservative treatment leads to a bacterial sanation in about 70%. In patients with superposed pyelonephritis at first the basic disease is to be treated, i.e. the metabolic disturbances are to be compensated and at the same time an antibacterial therapy is to be performed.

Adult↗

PubMed1993

[Clinical description of acute pyelonephritis].

Acute pyelonephritis is frequent. Its usual signs and symptoms comprise renal pain, fever, inflammation, and presence of germs and leukocytes in the urine. Primary acute E. coli pyelonephritis is frequent in the young female and in most cases is a benign condition. Atypical pyelonephritis may be painless, or without high fever, or lacking bacterial growth in the urine owing to previous inappropriate treatment. Severe pyelonephritis is mainly observed in diabetic, alcoholic or immunocompromised patients. In occasional cases, a common form of pyelonephritis may develop to formation of a renal abscess requiring drainage. When secondary to urinary tract abnormalities, pyelonephritis may be complicated with septicaemia and can induce early and severe renal tissue damage. This form warrants early urological treatment. The common pyelonephritis of the young female without previous history of febrile urinary tract infection requires little imaging. Conversely, extensive uroradiological workup is mandatory in the very young and the elderly, in the male, when treatment is not rapidly effective or in case or early relapse. In some cases, pyelonephritis leads to the development of cortical scars, the long-term prognosis of which remains to be determined.

Abscess↗

PubMed1997

Surgical management of grades III and IV primary vesicoureteral reflux in children with and without acute pyelonephritis as breakthrough infections: a comparative analysis.

PURPOSE: Although high grade vesicoureteral reflux associated with breakthrough infection may be an indication for surgical intervention, it remains uncertain whether acute pyelonephritis as breakthrough infection is a risk for renal scar formation and whether surgery performed without it has any advantage. We assessed the results of antireflux surgery for high grade vesicoureteral reflux in children with and without acute pyelonephritis as breakthrough infections. MATERIALS AND METHODS: A total of 33 boys and 27 girls (102 refluxing units) less than 3 years old with grades III and IV vesicoureteral reflux who underwent surgical management because of breakthrough infections were retrospectively studied in a 3-year period. Of the 60 patients 30 (group 1) presented with breakthrough infections of acute pyelonephritis, although they were maintained on prophylactic antibacterials. The remaining 30 patients (group 2) underwent surgery without acute pyelonephritis as the breakthrough infections. There was no renal scar formation at the diagnosis of vesicoureteral reflux in either group. Patients with renal scars were excluded from study. There was no significant difference in patient gender (p = 0.795) or distribution of bilateral vesicoureteral reflux (p = 0.781) in the groups. Group 1 patients were significantly younger at the diagnosis of vesicoureteral reflux (p = 0.006). RESULTS: Although 55 patients presented with a febrile urinary tract infection at the diagnosis of vesicoureteral reflux, the infection was not significantly related to the development of renal scars (p = 0.066). Of the 55 patients 12 presented with acute pyelonephritis as the initial episode of urinary tract infection. The presence of acute pyelonephritis at the diagnosis of vesicoureteral reflux was also not significantly related to renal scar formation (p = 0.207). Postoperative urinary tract infections developed in 34 patients but there was no significant correlation between postoperative urinary tract infections and renal scar formation (p = 0.235). At followup 17 group 1 and 7 group 2 patients (29 renal units) were found to have renal scars. CONCLUSIONS: Renal scars were significantly more common in younger children with than without acute pyelonephritis as breakthrough infections (p = 0.010). Although breakthrough infections in high grade reflux may be an indication for antireflux surgery, the most appropriate results were achieved when acute pyelonephritis was not a breakthrough infection.

Acute Disease↗

PubMedDate not supplied

The characteristics and hospital course of patients admitted for presumed acute pyelonephritis.

To study the characteristics and hospital courses of patients hospitalized for presumed acute pyelonephritis, the authors analyzed 185 cases. Judged by explicit clinical and laboratory criteria, 54% of the patients definitely had pyelonephritis, 22% probably had pyelonephritis, 9% possibly had pyelonephritis, and 16% did not have pyelonephritis. In pretreatment urine cultures, 79% of patients had a single pathogen and 77% had colony counts of 100,000 or more organisms per ml. Non-Escherichia coli infections and positive blood cultures were the only two independent predictors of the concomitant renal stones or genitourinary tract abnormalities that were found in 29% of patients with pyelonephritis. About 15% of all patients continued to have temperatures greater than or equal to 101 degrees F 48 hours after the initiation of antibiotic therapy, but persistent fever did not correlate with a history of prior urinary tract infection, the presence of resistant pathogens, renal stones, or genitourinary tract abnormalities. The authors conclude that many of these patients did not have pyelonephritis, and that certain characteristics correlate with the presence of underlying anatomic abnormalities.

Acute Disease↗

PubMed1994

Renal scarring after acute pyelonephritis.

Seventy six children, 18 boys and 58 girls, aged 0-15.9 (median 1.0) years, with acute pyelonephritis were prospectively studied with a technetium-99m dimercaptosuccinic acid (DMSA) scan during infection and two months later. Fifty nine of these children were also studied two years after the infection. Seventeen children with a normal DMSA scan during infection or at two months after infection, or both, were not investigated by a DMSA scan at two years after acute pyelonephritis. A micturition cystourethrogram was performed in all the children after two months. Changes on the DMSA scan were found in 65 (86%) children during acute pyelonephritis, in 45 (59%) children at two months, and in 28 (37%) children at two years after infection. Vesicoureteric reflux (VUR) was found in 19 (25%) children at two months. Renal scarring was significantly correlated with the presence of gross VUR and recurrent pyelonephritis, but 62% of the scarred kidneys were drained by non-refluxing ureters. Children with scars were older at the time of acute pyelonephritis than those without scars but no difference was found between the groups with regard to duration of illness, levels of C reactive protein and maximum white cell count, glomerular filtration rate, nor renal concentration capacity at the time of infection. It is concluded that renal scarring after acute pyelonephritis in children is more common than has been previously thought. Although children with gross VUR and recurrent pyelonephritis are at the greatest risk, renal scarring is more often seen without these risk factors.

Acute Disease↗

PubMed1989

[Chronic pyelonephritis in polycystic kidney].

The characteristics of chronic pyelonephritis are studied in 37 patients out of a total of 53 patients with proved renal polycystosis. A group of 71 patients with chronic pyelonephritis selected at random are used as a control group. The frequency of chronic pyelonephritis among the patients with renal polycystosis is 69.8%. The difference between the mean age of the patients with renal polycystosis and chronic pyelonephritis and the patients with renal polycystosis without chronic pyelonephritis is 8.6 years. A significant difference is established between these two groups of patients concerning the frequency of symptomatic hypertension--89.2% for the patients with renal polycystosis and chronic pyelonephritis and 45% for the patients with uncomplicated renal polycystosis. A similar difference is established also for the renal failure--respectively 64.9% and 37.5%. The frequency of hypertension and chronic renal failure is lower in the control group of patients. 59% of the patients with renal polycystosis and chronic pyelonephritis have significant bacteriuria, E. coli and Proteus being the most frequently isolated bacteria but Pseudomonas shows the highest drug resistance. The isolated bacteria are most sensitive to nitroxoline and aminoglycoside antibiotics.

Adolescent↗

PubMedDate not supplied

[Fibronectin and its significance in pyelonephritis].

Fibronectin levels were measured by enzyme immunoassay in 68 patients with pyelonephritis and 10 patients with chronic cystitis. The patients with chronic cystitis, acute and chronic non-obstructive pyelonephritis exhibited significantly high average blood fibronectin levels, whereas those with chronic obstructive pyelonephritis displayed the levels slightly different from those observed in healthy individuals. Hypofibronectinemia was detected in 23.3% of patients with chronic pyelonephritis. Preincubation of the neutrophils isolated from pyelonephritis patients with fibronectin increased the initially low phagocytic capacity without enhancing their metabolic activity. In experimental pyelonephritis, administration of exogenous fibronectin was demonstrated to contribute to a rapid bacterial elimination from the kidneys, to decrease the intensity of an inflammatory response, to prevent renal histostructural lesions, to enhance the functional activity of immunocompetent cells and to stabilize their membranes. The findings may serve the basis for using fibronectin in clinical practice as a promising agent to treat pyelonephritis.

Acute Disease↗

PubMed1977

[Tubular kidney dysfunction and its etiology in chronic pyelonephritis].

1. The renal dysfunction in the chronic compensated pyelonephritis means a selective decrease of the maximum osmotic concentration power, the ammonia secretion and the total secretion of hydrogen ions in the glomerular filtration rate, proximal reabsorption of the fluid of the tubule, excretion of osmotically free water and acidity of the urine which can be titrated. 2. The functional distrubances observed in chronic pyelonephritis do not as a whole differ from those disturbances in chronic compensated glomerulonephritis, but in the disease first mentioned there is in every case no decrease of the endogenic creatinine clearance and the maximum water diuresis. 3. The latent chronic pyelonephritis differs from the latent chronic glomerulonephritis by a normal endogenic creatinine clearance and maximum water diuresis and by a decrease of the ammonia and hydrogen ion secretion. These disturbances to a certain extent may be regarded as specific for the chronic pyelonephritis. In comparison with the chronic hypertonic pyelonephritis in the chronic hypertonic pyelonephritis the maximum water diuresis is normal and the titratable acidity is slightly increased. 4. The kind of renal dysfunctions can be of importance for the differential diagnosis between chronic glomerulonephritis and chronic pyelonephritis particularly in the latent forms of the two diseases.

Chronic Disease↗

PubMed1980

[Transplant pyelonephritis (author's transl)].

Examinations of the urine in 216 kidney allograft recipients resulted in significant bacteriuria in 274 samples of 1,802 urines tested. Bacteruria was found in 30 patients with recurrent or chronic persistent infections of the urinary tract; this patient group was studied by examination of 399 urine samples (mean 13.3 samples per patient). Four patients suffered from urologic complications after kidney grafting and were excluded from the study; 15 patients were diagnosed clinically and/or histologically with transplant pyelonephritis, 11 patients with cystitis. Of main importance for the diagnosis of transplant pyelonephritis were findings of persistent leucocyturia and the presence of antibody-coated bacteria. Both of these findings were repeatedly seen in all patients with transplant pyelonephritis. Clinical symptoms included fever and dysuria. In contrast to patients suffering from cystitis, transplant function detoriated in 13 of 15 patients with transplant pyelonephritis; two patients had to be treated by hemodialysis. Septicemia occurred in eight of the 15 patients studied. The data illustrate the frequency of transplant pyelonephritis as observed in 15 of 26 patients accompaining chronic urinary tract infection after kidney allograft transplantation. As a predisposing factor, obstruction of the urinary tract was diagnosed in eight of the 15 transplant recipients with pyelonephritis. The prednisone dose was higher than 10 mg in eight of 15 patients at the time transplant infection was diagnosed. Successful antibiotic treatment resulted in stable transplant function in three patients; four patients exhibited even lower serum creatinine levels after therapy.

Adult↗

PubMed1991

Renal pelvicalyceal dilation in antepartum pyelonephritis: ultrasonographic findings.

The purpose of the present study was to determine whether pregnant women with pyelonephritis have differences of pelvicalyceal systems, compared with normal pregnant control subjects, that might predispose to upper urinary tract infection. Ultrasonographic examination of both kidneys in coronal and axial planes of 24 women with clinical pyelonephritis and positive urine cultures was compared with results in control subjects matched for gestational age, parity, and race. Women with right or bilateral pyelonephritis had increased dilation of the right calyceal system, compared with controls (1.7 cm vs 0.8 cm, p less than 0.001). Renal pelvis volume was increased as well (29.3 vs 5.5 cm3, p less than 0.001). Renal pelvicalyceal dilation in antepartum pyelonephritis was significantly increased compared with normal physiologic dilation of pregnancy. Follow-up nephrosonography in a small number of women (N = 10) after treatment of pyelonephritis did not reveal a consistent decrease in renal dilation, suggesting that dilation of the renal pelvis may antedate pyelonephritis. Further study of this phenomenon is warranted.

Dilatation, Pathologic↗

PubMed1991

Parenteral ofloxacin in treatment of pyelonephritis.

The interim findings of two studies of intravenous ofloxacin for the treatment of pyelonephritis are presented. The findings are from one center of a multicenter trial. In the first study intravenous (IV) ofloxacin was given to 34 patients with urine-culture-positive pyelonephritis. After three days of intravenous therapy patients could be switched to oral ofloxacin. Microbiologic eradication occurred in 97 percent and clinical cures in 97 percent of the patients treated with ofloxacin. There were three probable drug-related adverse events. In the second comparative study 38 patients with pyelonephritis were randomized to receive IV ofloxacin with the option of switching to oral ofloxacin after three days. IV ceftazidime was given to 30 patients with pyelonephritis with the option of switching to trimethoprim/sulfamethoxazole (TMP/SMX) after three days. Microbiologic cures were experienced by 97 percent of the ofloxacin patients and by 100 percent of the ceftazidime patients. Probable drug-related adverse reactions were experienced by 3/28 ofloxacin patients and by none of the ceftazidime patients. These interim study findings indicate that the intravenous preparation of ofloxacin is efficacious in the treatment of pyelonephritis and that it is safe. In addition, IV ofloxacin is as efficacious as IV ceftazidime for the treatment of pyelonephritis.

Administration, Oral↗

PubMed1987

Pyelonephritis following pediatric renal transplant: increased incidence with vesicoureteral reflux.

The association between pyelonephritis and vesicoureteral reflux (VUR) following pediatric renal transplantation is unclear. To understand the relationship of vesicoureteral reflux with urinary tract infection (UTI) and pyelonephritis, 67 patients were evaluated for reflux and pyelonephritis. Sixty-seven pediatric patients, aged 2 to 18 (39 males and 28 females) underwent renal transplantation. Beginning in 1982, all patients underwent voiding cystourethrography or radionuclide voiding studies 1 to 3 months postoperatively to assess the incidence of VUR. Techniques of ureteroneocystostomy (UNC) included the Leadbetter-Politano (L-p) in 39 cases, and two different modifications of the LICH (herein called LICH-1 and LICH-2) in 30 cases. Urinary cultures were performed routinely. Pyelonephritis was considered present in any patient with UTI and increased serum creatinine or fever greater than 38.5. VUR occurred in 36% of patients; highest in LICH-1 (79%), intermediate in L-P (22%), and lowest in LICH-2 (9%). VUR was not statistically significantly higher in females (43%) v males (31%). UTI occurred in 37% of patients. The difference in incidence between females (54%) and males (26%) was significant (P less than .05). The frequency of UTI in patients with VUR was 46% v 33% in patients without reflux (NS). However, pyelonephritis that occurred in 16% of cases overall was present in 82% of UTIs in patients with reflux v 14% of UTIs in patient without reflux (P less than .01). Pyelonephritis is significantly increased in pediatric renal transplant patients with UTI was have VUR. A nonrefluxing UNC is advocated in all patients. All renal transplant patients should have routine monitoring of urinary cultures and should be evaluated of VUR posttransplant.

Adolescent↗