Urinary tract infections in children after renal transplantation

Markus J Kemper,Ulrike John

doi:10.1007/s00467-007-0690-0

Markus J Kemper, Ulrike John

Open Access

https://doi.org/10.1007/s00467-007-0690-0

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Abstract

Urinary tract infections (UTI) after pediatric kidney transplantation (KTX) are an important clinical problem and occur in 15–33% of patients. Febrile UTI, whether occurring in the transplanted kidney or the native kidney, should be differentiated from afebrile UTI. The latter may cause significant morbidity and is usually associated with acute graft dysfunction. Risk factors for (febrile) UTI include anatomical, functional, and demographic factors as well as baseline immunosuppression and foreign material, such as catheters and stents. Meticulous surveillance, diagnosis, and treatment of UTI is important to minimize acute morbidity and compromise of long-term graft function. In febrile UTI, parenteral antibiotics are usually indicated, although controlled data are not available. As most data concerning UTI have been accumulated retrospectively, future prospective studies have to be performed to clarify pathogenetic mechanisms and risk factors, improve prophylaxis and treatment, and ultimately optimize long-term renal graft survival.

Highlights

Kidney transplantation (KTX) is considered the treatment of choice for end-stage renal disease (ESRD) in children [1]
In chronic allograft nephropathy (CAN), specific immunological and nonimmunological risk factors, such as hypertension and urinary tract infections (UTI), seem to play a role [3, 4], so that the ultimate solution to the problem will rely on several approaches
Especially the retrospective cohort study of Abbott et al in nearly 29,000 adult renal transplant patients of the United States Renal Data System (USRDS) database is of interest, because late UTIs were independently associated with the risk of subsequent graft loss and even death [38]

Summary

Introduction

Kidney transplantation (KTX) is considered the treatment of choice for end-stage renal disease (ESRD) in children [1]. UTI diagnosis in healthy children and those with urinary tract malformations or after KTX should follow the Pediatr Nephrol (2009) 24:1129–1136 same principles Such patients after renal transplantation are more complex, as they are immunocompromised, often have anatomical urinary tract abnormalities, and maintenance of organ function is pivotal. A high prevalence of fUTI in children after renal transplantation has been demonstrated by several retrospective studies They are not limited to the immediate posttransplant period and occur later, especially in girls [14]. Surgery of the urinary tract before listing for transplantation is often necessary and should decrease the risk of infections, in our retrospective study, operated children per se had more UTIs, possibly because patients represent a specific population at risk, even after surgery [14]. Correction of vesicoureteric reflux into the kidney graft has been shown to reduce the incidence of UTI in a small series but was associated with obstructive complications [17], which may be high, especially in the cohort with associated abnormal bladder anatomy

Stents and other manipulations

Gender

Bladder dysfunction

Findings

Summary and conclusion