Urinary tract infections in children after renal transplantation

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.

Infections Following Kidney Transplant in Children: A Single-Center Study

“…In our study, the prevalence of febrile UTI was 28% which was in agreement with previous reports in pediatric renal transplantation studies that range between 15% and 33% [1] [2]. Febrile UTI after KT may lead to kidney damage, negatively affecting long-term graft survival by scarring and interstitial injury, although precise data for the pediatric population are scarce.…”

“…Febrile UTI after KT may lead to kidney damage, negatively affecting long-term graft survival by scarring and interstitial injury, although precise data for the pediatric population are scarce. Therefore, in order to prevent allograft damage induced by febrile UTI, aggressive and specific treatment is mandatory [2]. In our patients antibiotic therapy was frequently initiated if bacteriuria was present and severe infections were infrequently found.…”

“…Kidney transplantation (KT) is the treatment of choice for end-stage renal disease (ESRD) in children [1] [2]. Despite improvements on immunosuppressive therapy and surgical techniques, infections remain important complications and have been associated with increased morbidity and graft rejection [3] [4].…”

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“…It might present as either asymptomatic bacteriuria or symptomatic infection. 17 The rate of UTIs among patients with abnormal bladder tends to be high. 18,19 This may be in part due to the frequent use of CIC and the different surgical interventions required to repair the bladder, such as bladder augmentation and urinary diversion.…”

Recent advances in chronic dialysis and renal transplantation in children

“…Drs. John and Kemper will discuss "urinary tract infections after renal transplantation" [15], which occur in 15-33% of patients. Risk factors include anatomical, functional and demographic factors as well as immunosuppression and presence of foreign material, such as catheters and stents.…”