Summary
Our current knowledge of the long-term outcome of uncomplicated urinary tract infections in women is based on a re-evaluation of the criteria for defining pyelonephritis at autopsy, careful description of the causes of renal disease among patients entering dialysis and transplant programs, long term observation of patients, and epidemiologic studies which have attempted to determine the association of bacteriuria with mortality. The weight of the evidence favors the conclusion that although urinary tract infections can produce severe impairment of renal function, this is rare in the absence of a major predisposing factor such as obstruction, calculus, reflux, abnormalities of the voiding mechanism or diabetes. The predisposing lesions, however, may go undetected until heralded by episodes of acute pyelonephritis or by renal failure. Unfortunately, urinary tract infections are so common that it is difficult to distinguish the population at greatest risk. The possible role of renal damage produced by autoimmune mechanisms following infection needs continued study.
Unser derzeitiges Wissen über die Langzeitergebnisse bei unkomplizierten Harnwegsinfektionen der Frau basiert auf der kritischen Überprüfung der Kriterien für die pathologisch-anatomische Definition der Pyelonephritis, der sorgfältigen Dokumentation der Ursachen von Nierenerkrankungen bei Dialysepatienten und Transplantatempfängern, auf Langzeit-Überwachungsstudien an Patienten sowie auf epidemiologischen Studien zur Klärung der Assoziation von Bakteriurie und Sterblichkeit. Obwohl Harnwegsinfektionen zu einer schweren Beeinträchtigung der Nierenfunktion führen können, sprechen die vorhandenen Daten dafür, daß es ohne größere prädisponierende Faktoren wie Obstruktion, Konkrement, Reflux, Entleerungsstörungen oder Diabetes nur selten zur Niereninsuffizienz kommt. Diese prädisponierenden Faktoren können jedoch unentdeckt bestehen, bis sie durch eine akute Pyelonephritis oder Nierenversagen zum Vorschein kommen. Bei der Häufigkeit von Harnwegsinfektionen ist es schwer, die am stärksten gefährdete Gruppe abzugrenzen. Ein bedeutsamer Forschungsschwerpunkt für die Zukunft ist die Frage der durch Autoimmunmechanismen verursachten Nierenschädigung nach Infektionen.
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Kunin, C.M. Natural history of “lower” urinary tract infections. Infection 18 (Suppl 2), S44–S49 (1990). https://doi.org/10.1007/BF01643425
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DOI: https://doi.org/10.1007/BF01643425