Febrile urinary tract infection after pediatric kidney transplantation: a multicenter, prospective observational study

Abstract

This prospective study confirms a high incidence of fUTI after pediatric KTx, which is not restricted to patients with CAKUT; fUTIs have a negative impact on graft function during the infectious episode but not on 2-year graft outcome.

When does vesicoureteral reflux in pediatric kidney transplant patients need treatment?

“…While the population in this study is small, the overall eGFR for the combined group is consistent with graft function based on historical controls . As shown by Weigel et al, there are multiple factors that affect graft function, and it is difficult to show that management of VUR alone will impact eGFR. Patients who are found incidentally to have VUR after investigation for hydronephrosis and abnormal renal biopsies can be treated with bladder training and temporary antibiotic prophylaxis.…”

“…Surprisingly, functional bladder disorders do not increase the risk for UTI or the incidence of UTI after transplant, but patients with recurrent UTI have a more rapid decrease in GFR . Obstructive uropathy, pretransplant pyelonephritis, pretransplant vesicoureteral reflux, age <5 years, and congenital anomalies of the kidneys and urinary tract (mainly posterior urethral valves) have been identified as risk factors for post‐transplant UTI . However, at 2‐year follow‐up, no difference could be shown in eGFR between patients with febrile UTI and those without febrile UTI.…”

“…However, at 2‐year follow‐up, no difference could be shown in eGFR between patients with febrile UTI and those without febrile UTI. This was attributed to the study being underpowered (n = 98) and the complicating factor of acute rejection …”

The Contribution of Urinary Tract Infection to Chronic Kidney Disease in Children: An Entity in Evolution

“…To this end, a group of European investigators recently collaborated to design a prospective registry to record data on febrile UTI before and after pediatric kidney transplant. 34 To date, 98 subjects from 14 mid-European centers have been registered and completed 2-year followup. Post-transplant, 38.7% of subjects experienced at least one febrile UTI and at least one recurrence of UTI was noted in 58% of subjects.…”

Infections in Pediatric Kidney Transplant Recipients

“…With prevalence rates reported as high as 38.7% in children postkidney transplant, providers should have a low threshold for checking urine on children. 8,9 The optimal treatment course (10 vs. 14 days) and route for UTIs postkidney transplant have not been determined. Some recommend intravenous (IV) antibiotics depending on the presentation, and some recommend double coverage until the organism has been isolated.…”