{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T13:30:45Z","timestamp":1790602245693,"version":"4.1.0"},"reference-count":25,"publisher":"BMJ","issue":"6701","license":[{"start":{"date-parts":[[1989,9,16]],"date-time":"1989-09-16T00:00:00Z","timestamp":621907200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1989,9,16]]},"abstract":"<jats:p>OBJECTIVE--Determination of the long term incidence of uraemia, hypertension, and toxaemia in pregnancy associated with non-obstructive focal renal scarring after pyelonephritis in childhood 25-35 years earlier. DESIGN--27 Year follow up of patients with non-obstructive focal scarring identified from a retrospective review of intravenous urograms performed in childhood between 1951 and 1967. SETTING--Paediatric primary referral centre and urological clinic in tertiary referral centre. PATIENTS--30 Patients (mean age 33 (range 22-41] with non-obstructive focal renal scarring first detected between 1951 and 1967 and a history of febrile urinary tract infection. MAIN OUTCOME MEASURE--Hypertension and complications of renal damage. RESULTS--Three patients had developed end stage renal disease, seven had developed hypertension, two of 16 women had a history of toxaemia during pregnancy, and seven patients had undergone renal surgery during follow up. Of the 20 patients who had neither had renal surgery nor had end stage renal disease, all had a significantly lower glomerular filtration rate and renal plasma flow and higher diastolic blood pressure, mean arterial blood pressure, plasma renin activity, and serum beta 2 microglobulin concentration than 13 healthy age matched controls. Diastolic blood pressure and plasma renin activity were positively correlated (r = 0.50, p less than 0.05) and so were fractional sodium excretion and both systolic and diastolic blood pressures (r = 0.54, p less than 0.01, r = 0.51, p less than 0.01 respectively). The progress of renal damage was unrelated to the incidence of recurrent infections. CONCLUSIONS--Children with focal renal scarring due to pyelonephritis are at high risk of serious long term consequences. It is essential that they are given adequate attention and care during adolescence and pregnancy.<\/jats:p>","DOI":"10.1136\/bmj.299.6701.703","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"703-706","source":"Crossref","is-referenced-by-count":353,"title":["Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up."],"prefix":"10.1136","volume":"299","author":[{"given":"S. H.","family":"Jacobson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O.","family":"Ekl\u00f6f","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. G.","family":"Eriksson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L. E.","family":"Lins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B.","family":"Tidgren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Winberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[1989,9,16]]},"reference":[{"key":"ref_1","first-page":"235","article-title":"Demography of dialysis and transplantation in children in Europe 1985","volume":"3","author":"l'P, Brunner; M, Broyer; H, Brynger","year":"1988","unstructured":"Brunner l'P, Broyer M, Brynger H, et al. Demography of dialysis and transplantation in children in Europe 1985. Nephrol Dial Transplant 1988;3:235-43.","journal-title":"Nephrol Dial Transplant"},{"key":"ref_2","first-page":"4","article-title":"Glomerular lesions in atrophic pyelonephritis and reflux nephropathy","volume":"8","author":"Kincaid-Smith, P.","year":"1975","unstructured":"Kincaid-Smith P. Glomerular lesions in atrophic pyelonephritis and reflux nephropathy. Kidnev Int 1975;8(suppl 4):81-3.","journal-title":"Kidnev Int"},{"key":"ref_3","first-page":"5","article-title":"Hypertension in children with chronic pyelonephritis","volume":"8","author":"Holland, N.H.; Kotchen, T.; Bathena, D.","year":"1975","unstructured":"Holland NH, Kotchen T, Bathena D. Hypertension in children with chronic pyelonephritis. Ktdney Int 1975;8(suppl 5):243-51.","journal-title":"Ktdney Int"},{"key":"ref_4","first-page":"48","article-title":"Familial and hereditary reflux nephropathy","author":"Heale, W.F.; Shannon, T.; Utley, W.L.F.; Rolleston, G.L.","year":"1979","unstructured":"Heale WF, Shannon T, Utley WLF, Rolleston GL. Familial and hereditary reflux nephropathy. In: Hodson J, Kincaid-Smith P, eds. Reflux nephropaths'. New York: Masson, 1979:48-52."},{"key":"ref_5","first-page":"68","article-title":"Peripheral plasma renin actisity, hyperteitsion and renal scarring in children","volume":"39","author":"Dillon, M.J.; Smellie, J.M.","year":"1984","unstructured":"Dillon MJ, Smellie JM. Peripheral plasma renin actisity, hyperteitsion and renal scarring in children. Contnrb Nephrol 1984;39:68-80.","journal-title":"Contnrb Nephrol"},{"key":"ref_6","first-page":"47","article-title":"Role of hypervolaemia and renin in the blood pressure control of patients with pyelonephritic renal scarring","volume":"224","author":"Jacobson, S.H.; Kjellstrand, C.M.; Lins, L.-E.","year":"1988","unstructured":"Jacobson SH, Kjellstrand CM, Lins L-E. Role of hypervolaemia and renin in the blood pressure control of patients with pyelonephritic renal scarring..ActaMedScand 1988;224:47-53.","journal-title":"ActaMedScand"},{"key":"ref_7","first-page":"669","article-title":"Radiological diagnosis of pyelonephritis","volume":"52","author":"Hodson, C.J.","year":"1959","unstructured":"Hodson CJ. Radiological diagnosis of pyelonephritis. Proceedings of the Royal Societs of Medicine 1959;52:669-72.","journal-title":"Proceedings of the Royal Societs of Medicine"},{"key":"ref_8","first-page":"4","article-title":"Vcsico-ureteric reflux and renal scarring","volume":"8","author":"Smellie, J.; Edwards, D.; Hunter, N.; Normand, I.C.S.; Prescod, N.","year":"1975","unstructured":"Smellie J, Edwards D, Hunter N, Normand ICS, Prescod N. Vcsico-ureteric reflux and renal scarring. Kidney Int 1975;8(suppl 4):65-72.","journal-title":"Kidney Int"},{"key":"ref_9","first-page":"191","article-title":"Natural history of chronic pyelonephritic scarring","volume":"ii:","author":"Hodson, C.J.; Wilson, S.","year":"1965","unstructured":"Hodson CJ, Wilson S. Natural history of chronic pyelonephritic scarring. BrMed_ 1965;ii:191-4.","journal-title":"BrMed_"},{"key":"ref_10","first-page":"396","article-title":"The natural history of chronic pyelonephritis in the adult","volume":"51","author":"Arze, R.S.; Ramos, J.M.; Owen, J.P.","year":"1982","unstructured":"Arze RS, Ramos JM, Owen JP, et al. The natural history of chronic pyelonephritis in the adult. QJ Med 1982;51:396-410.","journal-title":"QJ Med"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1307","DOI":"10.1136\/bmj.285.6351.1307","article-title":"Glomerular filtration rate in schoolgirls with covert bacteriuria","volume":"285","author":"G.M.","year":"1982","unstructured":"Verrier-Jones K, Asscher AW, Verrier-Jones ER, Mattholie K, Leach K, Thomson GM. Glomerular filtration rate in schoolgirls with covert bacteriuria. Br Medy 1982;285:1307-10.","journal-title":"Br Medy"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1136\/adc.56.8.593","article-title":"Effect of vesicoureteric rcflux on renal growth in children with urinary tract infection","volume":"56","author":"Smellie, J.; Edwards, D.; Normand, I.C.S.; Prescod, N.","year":"1981","unstructured":"Smellie J, Edwards D, Normand ICS, Prescod N. Effect of vesicoureteric rcflux on renal growth in children with urinary tract infection. Arch Dis Child 1981;56:593-600.","journal-title":"Arch Dis Child"},{"key":"ref_13","first-page":"693","article-title":"Symptomatic recurrent urinary tract infections in patients with renal scarring in relation to fecal colonization with P-fimbriated Escherichia coli.j Urol","volume":"137","author":"Jacobson, S.H.; Kallenius, G.; Lins, L.-E.; Svenson, S.B.","year":"1987","unstructured":"Jacobson SH, Kallenius G, Lins L-E, Svenson SB. Symptomatic recurrent urinary tract infections in patients with renal scarring in relation to fecal colonization with P-fimbriated Escherichia coli.j Urol 1987;137:693-6."},{"key":"ref_14","first-page":"900","article-title":"P-fimbriae receptors in patients with chronic pyelonephritis.j Urol","volume":"139","author":"Jacobson, S.H.; Kallenius, G.; Lins, L.E.; Svenson, S.B.","year":"1988","unstructured":"Jacobson SH, Kallenius G, Lins LE, Svenson SB. P-fimbriae receptors in patients with chronic pyelonephritis.j Urol 1988;139:900-3."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1136\/adc.42.221.34","article-title":"Severe hypertension in children","volume":"42","author":"Still, J.L.; Cottom, D.","year":"1967","unstructured":"Still JL, Cottom D. Severe hypertension in children. Arch Dis Child 1967;42:34-9.","journal-title":"Arch Dis Child"},{"key":"ref_16","first-page":"225","article-title":"Covert urinary tract infections in children","volume-title":"diseases in nephrology","author":"Verrier-Jones, K.; Verrier-Jones, E.R.; Asscher, A.W.","year":"1986","unstructured":"Verrier-Jones K, Verrier-Jones ER, Asscher AW. Covert urinary tract infections in children. In: Asscher AW, Brumfitt W, eds. Microbial diseases in nephrology. Chichester: Wiley, 1986:225-39."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"678","DOI":"10.1136\/adc.62.7.678","article-title":"Five year prospective study of plasma renin activity and blood pressure in patients with longstanding reflux nephropathy","volume":"62","author":"Savage, J.M.; Koh, C.T.; Shah, V.; Barratt, T.M.; Dillon, M.J.","year":"1987","unstructured":"Savage JM, Koh CT, Shah V, Barratt TM, Dillon MJ. Five year prospective study of plasma renin activity and blood pressure in patients with longstanding reflux nephropathy. Arch Dis Child 1987;62:678-82.","journal-title":"Arch Dis Child"},{"key":"ref_18","first-page":"27","article-title":"Beta-2-microglobulin in clinical medicine. Scandj Clin Lab Invest","volume":"40","author":"Karlsson, F.A.; Wibell, L.; Esrin, P.E.","year":"1980","unstructured":"Karlsson FA, Wibell L, Esrin PE. Beta-2-microglobulin in clinical medicine. Scandj Clin Lab Invest 1980;40(suppl):27-37."},{"key":"ref_19","first-page":"81","article-title":"Glomerular lesions in atrophic pyelonephritis and reflux nephropathy","volume":"8","author":"Kincaid-Smith, P.","year":"1975","unstructured":"Kincaid-Smith P. Glomerular lesions in atrophic pyelonephritis and reflux nephropathy. Kidney Int 1975;8:81-3.","journal-title":"Kidney Int"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1111\/j.1479-828X.1987.tb00955.x","article-title":"laregnancy outcome in women with reflux nephropathy -a review of experience at the Royal Women's Hospital Brisbane, 1977-1986","volume":"27","author":"Weaver, E.; Crasswell, P.","year":"1987","unstructured":"Weaver E, Crasswell P. laregnancy outcome in women with reflux nephropathy -a review of experience at the Royal Women's Hospital Brisbane, 1977-1986. Aust N Zj Obstet Gynaecol 1987;27: 106-11.","journal-title":"Aust N Zj Obstet Gynaecol"},{"key":"ref_21","first-page":"2043","article-title":"Pregnancy-related renal disease","volume-title":"kidnev: physiology and pathophysiology","author":"Kincaid-Smith, P.","year":"1985","unstructured":"Kincaid-Smith P. Pregnancy-related renal disease. In: Seldin DW, Giebisch G, eds. 7he kidnev: physiology and pathophysiology. New York: Raven, 1985:2043-58."},{"issue":"1986","key":"ref_22","first-page":"796","article-title":"Effect of pregnancy on moderate renal failure in reflux nephropathy","volume":"7","author":"Becker, G.J.; Ihle, B.U.; Fairley, K.F.; Bastos, M.; Kincaid-Smith, P.","unstructured":"Becker GJ, Ihle BU, Fairley KF, Bastos M, Kincaid-Smith P. Effect of pregnancy on moderate renal failure in reflux nephropathy. Br Med 7 1986;292:796-8.","journal-title":"Br Med"},{"key":"ref_23","first-page":"991","article-title":"Effect of symptomatic bacteriuria in childhood on subsequent pregnancy","volume":"ii:","author":"Sacks, S.H.; Verrier-Jones, K.; Roberts, R.; Asscher, A.W.","year":"1987","unstructured":"Sacks SH, Verrier-Jones K, Roberts R, Asscher AW. Effect of symptomatic bacteriuria in childhood on subsequent pregnancy. Lancet 1987;ii:991-4.","journal-title":"Lancet"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"963","DOI":"10.1136\/adc.58.12.963","article-title":"Age as a main determinant of renal functional damage in urinary tract infection","volume":"58","author":"Berg, U.B.; Johansson, B.","year":"1983","unstructured":"Berg UB, Johansson B. Age as a main determinant of renal functional damage in urinary tract infection. Arch Dis Child 1983;58:963-9.","journal-title":"Arch Dis Child"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1111\/j.1651-2227.1981.tb06244.x","article-title":"The value of level diagnosis of childhood urinary tract infection in predicting renal injury","volume":"70","year":"1981","unstructured":"Pvlkkanen J, Vilska J, Koskimies 0. The value of level diagnosis of childhood urinary tract infection in predicting renal injury. Acta Paediatr Scand 1981;70:879-83.","journal-title":"Acta Paediatr Scand"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.299.6701.703","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.299.6701.703","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T08:03:18Z","timestamp":1765267398000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.299.6701.703"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,9,16]]},"references-count":25,"journal-issue":{"issue":"6701","published-online":{"date-parts":[[1989,9,16]]},"published-print":{"date-parts":[[1989,9,16]]}},"alternative-id":["10.1136\/bmj.299.6701.703"],"URL":"https:\/\/doi.org\/10.1136\/bmj.299.6701.703","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1989,9,16]]}}}