Acute Pyelonephritis Represents a Risk Factor Impairing Long-Term Kidney Graft Function

Abstract

Urinary tract infections (UTIs) and acute pyelonephritis (APN) often occur after renal transplantation, but their impact on graft outcome is unclear. One hundred and seventy-seven consecutive renal transplantations were investigated to evaluate the impact of UTIs and APN on graft function. The cumulative incidence of UTIs was 75.1% and that of APN was 18.7%. UTIs occurred mainly during the first year after transplantation and Escherichia coli, Pseudomonas aeruginosa and Enteroccocus sp. were the most frequent pathogens identified. The risk of developing APN was higher in female (64%) than in male recipients, and was correlated with the frequency of recurrent UTIs (p < 0.0001) and rejection episodes (p = 0.0003). APN did not alter graft or recipient survival, however, compared to patients with uncomplicated UTIs, patients with APN exhibited both a significant increase in serum creatinine and a decrease in creatinine clearance, already detected after 1 year (aMDRD-GFR: APN: 39.5 ± 12.5; uncomplicated UTI: 54.6 ± 21.7 mL/min/1.73 m 2 , p < 0.01) and still persistent (∼ − 50%) 4 years after transplantation. Multivariate analysis revealed that APN represents an independent risk factor associated with the decline of renal function (p = 0.034). Therefore, APN may be associated with an enduring decrease in renal graft function.

Gram-negative sepsis following biopsy of a transplant recipient with asymptomatic allograft pyelonephritis

“…Both UTIs and AGPN can progress and lead to bacteremia with an increased risk of morbidity and mortality, especially during the first 6-month posttransplant. This time coincides with the highest risk of acute rejection and when immunosuppressive therapy is at its maximum [1,2,[6][7][8].…”

“…Reports of the effect of AGPN on long-term graft and patient survival are conflicting with some showing a deleterious effect and others no difference. Pelle et al reported that AGPN was associated with poorer long-term renal graft function and Giral et al reported that the early AGPN (within the first 3 months) was significantly detrimental for graft outcome, independent of acute rejection [6,7]. Fiorante et al, however, reported no association between AGPN and long-term graft survival [8].…”

Renal transplantation parenchymal complications: what Doppler ultrasound can and cannot do

“…Important risk factors for this complication include immunosuppressive therapy, invasive urological procedures such as bladder catheterism or urethral stenting and post-transplantion urethral bladder reflux (Fig. 2) [15]. AGP should always be suspected if the patient suddenly develops fever of unknown aetiology, leucocytosis and leucocyturia as well as increased levels of C-reactive protein, even though all of them are also present in case of cystopyelitis.…”

“…AGP should always be suspected if the patient suddenly develops fever of unknown aetiology, leucocytosis and leucocyturia as well as increased levels of C-reactive protein, even though all of them are also present in case of cystopyelitis. Differential diagnosis is fundamental, because only AGP is responsible for parenchymal damage, increasing the risk of scarring, acute rejection and worsening of renal function [15]. The use of B-mode has low sensitivity (11-40 %) and low specificity (50 %) in detecting renal parenchymal lesions in case of AGP [15,16].…”

“…Differential diagnosis is fundamental, because only AGP is responsible for parenchymal damage, increasing the risk of scarring, acute rejection and worsening of renal function [15]. The use of B-mode has low sensitivity (11-40 %) and low specificity (50 %) in detecting renal parenchymal lesions in case of AGP [15,16]. Diagnostic accuracy increases if renal abscess or pyelonephritis with dilation of the excretory path is present [15,16].…”