Chronic pyelonephritis in association with neuropathic bladder.

Progressive chronic pyelonephritis (CPN) leading to renal failure was, in the past, a mode of death in children with meningomyelocele (MMC). With more sophisticated management modalities, renal failure is now uncommon, but the problem of CPN still remains. In this series of 100 children with MMC, 39% have CPN. It is significantly more common in girls than in boys. There is a strong relationship between CPN and vesico-ureteric reflux (VUR). There is no association with raised bladder pressure. The majority of CPN arises in children under the age of 4 years, but damaged kidneys can continue to deteriorate. Although chronic renal failure is rarely seen in children with MMC, there is a risk that this may merely be postponed into adulthood.