Bladder dysfunction in children and adolescents after renal transplantation

Abstract

The underlying mechanisms of urinary-tract infections (UTI) in renal transplant recipients are still not fully understood. In otherwise healthy children, bladder dysfunction increases the susceptibility to UTI. The aim of this study was to evaluate lower-urinary-tract function in children and adolescents after renal transplantation. Sixty-eight recipients of renal transplants, 5-20 years of age and 1-15 years after transplantation, were evaluated for their bladder function with a questionnaire, uroflowmetry and bladder ultrasound, and for renal function (glomerular filtration rate) by measuring clearance of inulin or iohexol. Forty-nine patients (72%) had some type of abnormality of bladder function. Abnormal bladder capacity was found in 26%, abnormal urinary flow in 50% and residual urine in 32% of the patients. There was no significant difference in bladder or renal function in children with urinary-tract malformations compared with those with normal urinary tract. Furthermore, there was no significant difference in renal function in patients with bladder dysfunction compared with those without. The incidence of bladder dysfunction is high in children and adolescents after renal transplantation, but the clinical significance of this finding and whether there is a correlation between bladder dysfunction and UTI in these patients need to be clarified further.

Urinary tract infections in children after renal transplantation

“…On the other hand, a recent retrospective study from Herthelius et al [33, 34] suggested no increased frequency of UTI after KTX in children with bladder dysfunction. However, the study did not analyze the effect of interventions in the patients with voiding dysfunction.…”

Pre-transplant management of valve bladder: A critical literature review

“…are comparable to those in non-urological kidney failure or other urological diseases [1][2][10][11]. Few authors have shown worse results in PUV patients (as compared to primary VUR [9] or 'clinical' cases [12]), but graft losses are attributed to problems unrelated to BD (vascular complications [9] and rejection/non-compliance to immunosuppressive therapy [9,12]).…”

“…These authors evaluated post-RT bladder function on 68/73 pediatric patients, who were subdivided into urological (eight PUV and four prune belly), congenital and acquired 'clinical' ESRD. Although daytime incontinence was present in six out of eight urological patients, abnormal bladder capacity, abnormal flow curves and high PVR were verified in the three groups and were more common than in 'normal' children [10].…”

Pediatric Bladder Disorders

“…Herthelius and Oborn evaluated bladder function (with a questionnaire, uroflowmetry, and bladder ultrasound) in 68 child recipients of a renal graft [135]. Among them, only 23 were transplanted for a urological illness (the remaining 45 were for glomerular of ischemic disease).…”