LONG-TERM URETHRAL CATHETERIZATION INCREASES RISK OF CHRONIC PYELONEPHRITIS AND RENAL INFLAMMATION

OBJECTIVE: To determine the prevalences of chronic pyelonephritis and chronic renal inflammation in elderly nursing home patients at the tim e of death and to assess correlation with urethral catheterization and other putative risk factors. DESIGN: Prospective assessment of risk f actors with the prevalences of chronic pyelonephritis and renal inflam mation at autopsy. SETTING: A 240-bed Long-term care facility. PARTICI PANTS: All residents greater than or equal to 65 years old who died an d were autopsied during a 2-year period. MEASUREMENTS: Antemortem asse ssment of risk factors for renal inflammation, including a search for any urethral catheterization in the person's life. Prospective assessm ent of urethral catheterization, catheter obstruction, and use of anti -inflammatory medications and urine cultures. Urinary tract pathology was assessed for gross and microscopic evidence of inflammation and ur inary tract stones. RESULTS: The duration of catheterization was signi ficantly associated with increasing prevalence of bacteriuria, polymic robial bacteriuria, chronic pyelonephritis, and chronic renal inflamma tion. The prevalence of chronic pyelonephritis at death was 10 percent (5/52) for patients catheterized >90 days during their last year of l ife and zero (0/65) when catheterized less than or equal to 90 days (P < 0.02; Fisher's exact test). Chronic pyelonephritis was significantl y associated with renal stones and hydronephrosis. The prevalence of c hronic renal inflammation without chronic pyelonephritis was significa ntly greater than that of chronic pyelonephritis: the prevalence was 4 3 percent (20/47) when catheterized >90 days and 18 percent (12/65) wh en less than or equal to 90 days (P < 0.05). Chronic renal inflammatio n was associated with hydronephrosis, ureteral dilatation, acute pyelo nephritis and diastolic hypertension. CONCLUSION: Chronic pyelonephrit is and chronic renal inflammation are associated with long-term cathet erization.