Long-Term Follow-Up of Women Hospitalized for Acute Pyelonephritis

Long-term outcome of acute pyelonephritis (AP) in adults is unknown. We evaluated the frequency of renal damage 10–20 years after hospitalization for AP in adult women and the utility of technetium Tc 99m–labeled dimercaptosuccinic acid (Tc 99m–DMSA) scanning for detection of renal scars; 63 of 203 women hospitalized with AP during 1982–1992 were included in the study. Tc 99m–DMSA scanning detected renal scarring in 29 women (46%). Multivariate analysis showed that pregnancy and hypoalbuminemia (albumin level,!3.2 g/dL) at hospitalization were independent risk factors for subsequent development of renal scars. At follow-up, hypertension was observed in approximately one-fifth of patients, regardless of renal scarring status. Four women with scars had a glomerular filtration rate of 75 mL/min; none of them developed severe renal impairment. In conclusion, the risk of developing renal scarring after AP in adult women is high. However, clinically relevant renal damage is rare 10–20 years after AP. Tc 99m–DMSA scanning is useful for detecting renal scars in adults but is not routinely needed in practice. Acute pyelonephritis (AP) and vesicoureteral reflux are relatively common in children, especially infants [1]. In 50%–60 % of affected children, reflux and inflammation produce irreversible lesions of the renal parenchyma [2