Impact of urinary tract infection and detrusor pressure on renal tubular function in patients with vesicoureteral reflux

Objective: The aim of this study was to evaluate prospectively the impact o f bacteriuria with or without pyuria and/or detrusor pressure on renal tubu lar function in patients with secondary vesicoureteral reflux. Methods: From October 1994 to December 1998, we evaluated 54 patients with secondary vesicoureteral reflux (26 men and 28 women; age 30 +/- 24 years), of whom 28 had a neurogenic and 26 a nonneurogenic voiding dysfunction. In a reference population (n = 48; 28 men, 20 women; age 38 +/- 14 years), 43 had a neurogenic and 5 a nonneurogenic voiding dysfunction. Urinary alpha- 1-microglobulin was measured immunonephelometrically. Statistical analysis was performed by multiple regression analysis. Results: Patients with vesicoureteral reflux had a significantly higher uri nary alpha-1-microgiobulin/creatinine ratio. Urinary alpha-1-microglobulin excretion was related to the grade of vesicoureteral reflux, detrusor press ure and compliance, but not to bacteriuria or pyuria, and was diagnostic fo r vesicoureteral reflux with a sensitivity of 90%, a specificity of 70% and a negative predictive value of 97%. Conclusion: Urinary alpha-1-microglobulin excretion is diagnostically usefu l in patients with secondary vesicoureteral reflux. The use of urinary alph a-1-microglobulin excretion in the follow-up of patients with vesicouretera l reflux has yet to be established. Copyright (C) 2001 S. Karger AG. Basel.