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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 of bacteriuria with or without pyuria and/or detrusor pressure on renal tubular function in patients with secondary vesicoureteral reflux. Methods: From October 1994 to December1998, 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 urinary alpha–1–microglobulin/creatinine ratio. Urinary alpha–1–microglobulin excretion was related to the grade of vesicoureteral reflux, detrusor pressure and compliance, but not to bacteriuria or pyuria, and was diagnostic for 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 useful in patients with secondary vesicoureteral reflux. The use of urinary alpha–1–microglobulin excretion in the follow–up of patients with vesicoureteral reflux has yet to be established.