Infection-related chronic interstitial nephropathy.

Kidney infection, when uncomplicated by anatomic abnormalities such as reflux or obstructing lesions, does not appear to lead to renal damage or hypertension. In children in whom predisposing anatomic causes (reflux) are particularly prominent or in adults who have or develop these abnormalities, progressive renal injury with hypertension can occur with infection. Infection appears to enhance the damaging effects of the underlying anatomic abnormalities. The mechanisms of progressive damage include the inflammatory effects of the infection itself, potentially "autoimmune" effects, and the inflammatory and infection-promoting effects of bacterial products, especially ammonia. After initial renal damage, the hemodynamic effects of systemic hypertension and of intrarenal hyperperfusion of residual nephrons may further promote progressive injury.