High incidence of urinary tract malignancy among patients with haematuria following kidney transplantation in Taiwan

Abstract

Haematuria is a common complication following kidney transplantation, but few studies describing post-transplant haematuria have been published. Herein, we investigated the incidence and etiologies of persistent hematuria with kidney transplant patients in Taiwan. The medical records of 189 kidney transplant recipients with functioning grafts were retrospectively reviewed. Any episode of haematuria during routine follow-up was recorded and evaluated. The patient characteristics, possible causes of haematuria and consequent managements were reviewed. Among the 189 patients, 44 patients (23.3%) experienced 45 episodes of persistent haematuria during routine monthly follow-up at our transplant clinic. Thirty-two episodes (71%) were microscopic haematuria and 13 (29%) were gross haematuria. The most prevalent etiology explained for the persistent haematuria in our series was urologic malignancy (19 patients, 42.2%), followed by urinary tract infections (24.5%) and unexplained reasons (17.8%). Furthermore, those patients with persistent haematuria caused by urologic malignancy were also associated with significantly longer duration following transplantation and worse graft function. Haematuria is frequently seen in kidney transplant recipients and the most prevalent cause in our series is urologic malignancy. Those patients were also associated with significantly poorer graft function; however, the mechanism is still unclear.

Hydronephrotic Urine in the Obstructed Kidney Promotes Urothelial Carcinoma Cell Proliferation, Migration, Invasion through the Activation of mTORC2-AKT and ERK Signaling Pathways

“…Urothelial carcinoma is the most common type of malignancy in both long-term dialysis patients and kidney transplant recipients in Taiwan [1–3]. Hydronephrosis, determined by ultrasonography, is the specific common finding of urothelial carcinoma in these patients [2–4].…”

“…Hydronephrosis, determined by ultrasonography, is the specific common finding of urothelial carcinoma in these patients [2–4]. Although the obstruction of urinary tract by the tumorous lesion is a reasonable cause of hydronephrosis, cancerous lesions are not always present in the obstructive site [2,3]. Moreover, a preoperative hydronephrosis grade can independently predict worse pathological outcomes in patients undergoing nephroureterectomy for upper tract urothelial carcinoma [4].…”

Evaluation of Salivary Indoxyl Sulfate with Proteinuria for Predicting Graft Deterioration in Kidney Transplant Recipients

“…However, due to a small number of events per variable, that model was not applied. Hematuria frequently occurs following Ktx, mostly due to urologic malignancy and urinary tract infection [ 24 , 25 ]. Hematuria has been already reported as an independent risk factor for CKD progression and death [ 26 ], but not for KTRs.…”

Gross hematuria as a sign of acute rejection

“…Gross hematuria is described as a clinical sign of rejection in studies dating back to the 1970s and early 1980s but not since then . A review of the contemporary literature reveals an emphasis on other causes of hematuria after transplantation including post‐biopsy arteriovenous malformations , pseudoaneurysms , adenoviral hemorrhagic cystitis or pyelonephritis , BK viral infections, bacterial urinary tract infections , renal stones , urothelial malignancies , and recurrent or de novo glomerular disease such as IgA nephropathy none of which were present in our patient. While we did not definitively rule out small stones (by performing the “gold standard” computerized tomography) or bladder cancers, the rarity of the latter, the absence of hydronephrosis, and the resolution of the hematuria following treatment for rejection make these highly improbable.…”