Acute kidney injury secondary to urinary tract infection in kidney transplant recipients

Abstract

Acute kidney injury (AKI) in kidney transplant recipients (KTRs) is a common, yet poorly investigated, complication of urinary tract infections (UTI) and urosepsis. A retrospective comparative analysis was performed, recruiting 101 KTRs with urosepsis, 100 KTRs with UTI, and 100 KTRs without history of UTI or sepsis. The incidences of AKI in the urosepsis and UTI groups were 75.2% and 41%, respectively. The urosepsis group has also presented with a significantly higher prevalence of AKI stage 2 and 3 than the UTI group. The rates of recovery from AKI stages 1, 2 and 3, were 75,6%, 55% and 26.1%, respectively. Factors independently associated with renal recovery from AKI were: AKI severity grade (AKI stage 2 with OR = 0.25 and AKI stage 3 with OR = 0.1), transfusion of red blood cells (RBC) (OR = 0.22), and the use of steroid bolus in the acute phase of treatment (OR = 4). The septic status (urosepsis vs UTI) did not influence the rates of renal recovery from AKI after adjustment for the remaining variables. The dominant cause of RBC transfusions in the whole population was upper GI-bleeding. In multivariable analyses, the occurrence of AKI was also independently associated with a greater decline of eGFR at 1-year post-discharge and with a greater risk of graft loss. In KTRs with both urosepsis and UTI, the occurrence of AKI portends poor transplantation outcomes. The local transfusion policy, modulation of immunosuppression and stress ulcer prophylaxis (which is not routinely administered in KTRs) in the acute setting may be modifiable factors that significantly impact long-term transplantation outcomes.

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation – update of recent literature

“…The inconsistency in findings among studies may be due to variations in study populations, methodology, and most importantly age category definitions [ 25 ▪▪ ]. To sum up increasing age was confirmed as significant risk factor in six studies [ 3 ▪▪ , 11 ▪▪ , 22 ▪▪ , 23 ▪▪ , 25 ▪▪ , 28 ] comparing to three [ 24 , 29 , 30 ] studies failing to prove this association.…”

“…At least one out of four KTX recipients will have a UTI during the first year after transplantation [ 11 ▪▪ , 12 ▪ ]. Yet, even these numbers may be an underestimation as shown in a recent study from Spain [ 13 ].…”

Acute Kidney Injury in Kidney Transplant Patients in Intensive Care Unit: From Pathogenesis to Clinical Management

“…Urosepsis and urinary tract infections (UTIs) are the most frequent infectious complications and the main causes of AKI in this population, mostly occurring within the first six months post-transplantation, presumably due to the intense immunosuppressive treatment regimen, the presence of ureteral stents and the unique anatomical configuration of the graft, including a shorter ureter, lacking anti-reflux properties and denervation that may hinder an early diagnosis [31,32]. Urosepsis and UTIs occurrence impinge upon graft survival and mortality, although there is insufficient data to determine the real burden.…”

“…Urosepsis and UTIs occurrence impinge upon graft survival and mortality, although there is insufficient data to determine the real burden. An increased risk of 1-year graft loss and/or worsening of graft function in KTRs with AKI secondary to UTIs, compared to transplanted patients who did not develop AKI, has been reported [31]. Data regarding the prevalence of etiologic agents are limited; however, bacterial infections are predominant, particularly related to Gram-negative bacteria.…”

Management of the kidney transplant recipient in the intensive care unit

“…Urinary tract infections (UTIs) and urosepsis are the most common infectious complication post kidney transplantation and represent nearly a quarter of infection-related ICU admissions [19 ▪ ]. Risk factors include the presence of ureteral stents and the anatomical positioning of the transplanted kidney, including shorter ureter, lack of antireflux properties and denervation that may result in delayed diagnosis [20 ▪ ]. Escherichia coli and Klebsiella pneumonia are the most common pathogens, however in recent years, increased incidence of multidrug resistant organisms (Enterobacteriaceae and pseudomonas species) and candida have been noted [21].…”