Denominators Do Matter: It's a Myth—Urinary Tract Infection Does Not Cause Chronic Kidney Disease

Pediatric practice is not different from other medical specialties: it is full of beliefs—some true and some false, some harmful and some not. Generations of budding pediatricians have been educated about the perils of urinary tract infection (UTI) in children. Since the 1950s we have been taught that UTI is not like other acute infectious illnesses that affect children,¹  and we have also propagated the belief that the clinical importance of UTI was not primarily about timely diagnosis and acute care of what is usually an unpleasant, febrile illness but, rather, about the risk of chronic kidney disease (CKD), hypertension, and ultimately end-stage kidney disease.² 

Looking back, the numerical disconnect between the dozens, even hundreds of children with UTI that we treated acutely and followed up and the extreme rarity of end-stage kidney disease caused by so-called reflux nephropathy was obvious but not recognized. Perhaps it is because...