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Primary and Secondary Renal Failure in a Total Community (Tecumseh, Michigan): Preponderance in the Elderly and Possible Antecedent Factors *

ABSTRACT: In 14 (8 men and 6 women) of the 8,641 original examinees in the Tecumseh Study, renal failure (RF) was found to have developed during an eight‐year period. The proportion rose significantly with age. At the initial examination (one to eight years before the onset of RF), no subject subsequently uremic had a history of acute glomerulonephritis or chronic renal disease nor was frankly azotemic, although in 4 there was a suggestion of early disease. Six of the 12 subjects (50 per cent) over age 45 who later became uremic gave a history compatible with urinary‐tract infection (UTI), compared with 380 (22 per cent) of the remaining 1,746 examinees in this age range. Conversely, in 6 of 386 persons (1.6 per cent) with a history of UTI, renal failure developed, in contrast to 6 of 1,372 persons (0.4 per cent) without such a history. Common disorders noted at the initial examination one to eight years before RF were congestive heart failure (9 cases), loss of hearing (7 cases), coronary heart disease (5 cases), hyperuricosemia (5 cases), and hyperglycemia (5 cases). This study shows that most persons in whom renal failure develops are elderly and have pre‐existing vascular disease; in about a quarter of them, the findings at the time of the initial examination indicate early renal disease. Although these data point to a relationship between UTI and RF in some cases, in most patients with a history of UTI, renal failure does not develop.