Attempts at Localization of Urinary Tract Infection

N RECENT YEARS there is increasing curiosity about the extent of urinary tract infection in the individual patient. Various avenues of investigation have been explored to find out whether (1) the infection is confined to the lower urinary tract, (2) is mainly in the lower urinary tract but due to reflux, the upper tract is at risk or (3) the upper tract is definitely involved. Radiographic investigation can reveal reflux or chronic pyelonephritic scarring. Renal concentration may be impaired in patients with kidney infection. 1-3 Alterations in renal cortical blood flow have been shown to occur in infants and children with urinary tract infections. 4 Creatinine clearance may be impaired. 5 Urinary acidification capacity and renal biopsy have also been assessedY ,6 In the 1960s, two fresh approaches have been advocated. Anatomic localization was shown to be of value by Stamey 7 and Fairley, s while serum antibody response to the 0 antigen of the infecting organism had its most vociferous support from Brumfitt and co-workers2 These approaches appear promising. In a pilot study on a group of girls with recurrent urinary tract infection we found that renal concentrating capacity and acidification mechanisms were of no value in localizing infection. The current study describes our recent attempts at localization using anatomical localization and measurement of specific antibody response. PATIENTS STUDIED The patients were all girls. Three midstream urine specimens with single-strain bacteruria in excess of 105/ml. were required for admission to the study. This represents the usual situation requiring further evaluation. Some of these patients were inpatients, others outpatients, and some were asymptomatic schoolgirls found on school screening for kidney disease. Only patients presenting for the first time were included. Fifty-six patients were found eligible for inclusion in the study. They were divided into six categories on an anatomical basis as follows: Category 1. Nine patients in this category were not localized because of acute illness where delay in commencing treatment was not justified. Two patients with spina bifida were also included in this group. All of this group had radiologie and serologic evaluation but did not have anatomical localization.