Late Recurrent Urinary Tract Infections May Produce Renal Allograft Scarring Even in the Absence of Symptoms or Vesicoureteric Reflux

Dupont, Peter; Psimenou, Erasmia; Lord, R.; Buscombe, J. R.; Hilson, A. J.W.; Sweny, P

doi:10.1097/01.tp.0000275377.09660.fa

Cited by 91 publications

(81 citation statements)

References 23 publications

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“…the findings from some studies have shown that GPN induces graft dysfunction (Giral et al 2002;Pelle et al 2007), the mechanism of graft dysfunction following GPN has not been clarified. The finding from one study suggested GPN could cause interstitial scars in renal allografts and a subsequent reduction in the functional nephron mass (Dupont et al 2007). On the other hand, bacterial infection is also likely to induce the activation of the immune system, leading to acute or chronic rejection.…”

Section: Discussionmentioning

confidence: 99%

“…The findings from some studies have shown that GPN is associated with interstitial scarring in renal allografts (Dupont et al 2007) and that it can activate an alloimmune response to the donor organ and subsequently contribute to acute or chronic rejection (Audard et al 2005;Locke et al 2009). In a previous cohort study, the occurrence of early-onset GPN following kidney transplantation was significantly associated with increased rates of renal allograft loss (Giral et al 2002).…”

Section: Introductionmentioning

confidence: 99%

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Early-Onset Graft Pyelonephritis Is Predictive of Long-Term Outcome of Renal Allografts

Shin

Kim

Lee

et al. 2015

Tohoku J. Exp. Med.

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Urinary tract infection (UTI) is the most common bacterial infection encountered in kidney transplant recipients. Graft pyelonephritis (GPN) is associated with acute kidney injury and renal allograft scarring. However, the influence of GPN on renal allograft outcome in kidney transplant recipients remains controversial. Two hundred sixty-five kidney transplant recipients were evaluated for the impact of earlyonset GPN on renal allograft functions between January 2001 and December 2011. Early-onset GPN was defined as the first GPN episode occurring within 6 months after kidney transplantation. Thirty recipients (11.3%) were diagnosed with early-onset GPN. During the mean follow-up period of 69.1 ± 28.9 months, 56 (21.1%) recipients showed renal allograft outcomes of a > 30% reduction in the estimated glomerular filtration rate (eGFR) over 2 years. The poor outcome was significantly more frequent in the early-onset GPN group (13 patients; 43.3%) than in those without early-onset GPN (43 patients; 18.3%) (P = 0.002). Moreover, the linear mixed model revealed a significant difference in the eGFR decline rate over time between the two groups (P < 0.001). Kaplan-Meier analysis showed that renal allograft event-free survival was significantly lower in the early-onset GPN group (P = 0.006). Multivariate Cox regression analyses revealed that early-onset GPN was independently predictive of poor renal allograft outcomes (hazard ratio, 1.96; 95% confidence interval, 1.02-3.77; P = 0.04). In conclusion, early-onset GPN is independently associated with impaired renal functions in kidney transplant recipients. Thus, early-onset GPN could be a predictor for long-term outcome of renal allografts.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early-Onset Graft Pyelonephritis Is Predictive of Long-Term Outcome of Renal Allografts

Shin

Kim

Lee

et al. 2015

Tohoku J. Exp. Med.

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“…Nevertheless, UTIs are frequent after renal transplantations (16) and may adversely impact renal allograft function, even in the absence of VUR (37,38). Dupont et al (32) evaluated whether the presence of VUR confers an increased risk for UTIs and renal allograft scarring.…”

Section: Discussionmentioning

confidence: 99%

Value of Routine Voiding Cystourethrography After Renal Transplantation

Margreiter

Györi

Böhmig

et al. 2013

American Journal of Transplantation

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The impact of vesicoureteral reflux (VUR) on renal allograft outcomes is debatable, with small cohort studies reporting controversial results. The objective of this retrospective study was to evaluate long-term clinical effects of early VUR in a large cohort of kidney transplant patients. Posttransplantation voiding cystourethrography was used to evaluate 646 consecutive kidney transplant recipients before discharge. The study endpoints included VUR grade, death-censored graft or patient survival, renal function, proteinuria and occurrence of urinary tract infections (UTIs). Of the 646 recipients, 263 (40.7%) were diagnosed with VUR. VUR grade II was most common (19.8%), followed by grades III (10.2%), I (7.9%) and IV (2.8%). VUR was less common in transplantations performed by experienced compared to inexperienced surgeons (36% vs. 48%; p = 0.004). VUR did not affect death-censored graft or patient survival and was not associated with proteinuria or occurrence of UTIs. Patients with VUR had a lower eGFR at 1 year after transplantation than did patients without VUR (60 vs. 52 mL/min/1.73 m 2 ; p = 0.02), although this difference was not observed at 3 and 5 years after transplantation. We conclude that early VUR, a common finding among renal transplant patients, may not have a meaningful impact on longterm transplant outcomes.

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“…В первый месяц после трансплантации почки у 50-70% реципиентов развиваются инфекции мочевы-водящих путей [5,7], оказывающие непосредственное влияние на функциональную состоятельность транс-плантата [15]. Частота инфекции мочевой системы составляет около 65,4% у больных с урологическими осложнениями после трансплантации и 40,7% -у па-циентов без урологических проблем.…”

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Etiopathogenenetic Aspects of Septic Complications and Urosepsis in Patients With Urological Disease Before and After Renal Transplantation: A Modern View on the Problem

Крстич¹,

Зулькарнаев²

2016

Alʹm. klin. med.

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ГБУЗ МО Московский областной научно-исследовательский клинический институт им. М.Ф. Владимирского (МОНИКИ)Гнойно-септические осложнения у пациентов с урологическими заболеваниями до и после транспланта-ции почки остаются одной из самых сложных клинических проблем современной нефрологии и транспланто-логии. Изучение различных аспектов этиологии и патогенеза гнойно-септических осложнений и уросепсиса у пациентов с хронической почечной недостаточностью до и после трансплантации почки открывает широкие возможности для их предупреждения, прогнозирования и лечения.Ключевые слова: гнойно-септические осложнения, уросепсис, трансплантация почки. ETIOPATHOGENENETIC ASPECTS OF SEPTIC COMPLICATIONS AND UROSEPSIS IN PATIENTS WITH UROLOGICAL DISEASE BEFORE AND AFTER RENAL TRANSPLANTATION: A MODERN VIEW ON THE PROBLEM M. Krstic, A.B. Zulkarnayev M.F. Vladimirsky Moscow Regional Clinical and Research Institute (MONIKI)Pyoseptic complications in patients with urologic diseases before and after renal grafting remain one of the most difficult clinical problems of contemporary nephrology and transplantation because of the high patient mortality that accounts for 60% even in the most prestigious domestic and foreign clinics. Studying different aspects of etiology and pathogenesis of pyoseptic complications and urosepsis in patients with chronic renal failure before and after renal transplantation opens wide opportunities for their prevention, prognosis, and treatment.

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Late Recurrent Urinary Tract Infections May Produce Renal Allograft Scarring Even in the Absence of Symptoms or Vesicoureteric Reflux

Cited by 91 publications

References 23 publications

Early-Onset Graft Pyelonephritis Is Predictive of Long-Term Outcome of Renal Allografts

Early-Onset Graft Pyelonephritis Is Predictive of Long-Term Outcome of Renal Allografts

Value of Routine Voiding Cystourethrography After Renal Transplantation

Etiopathogenenetic Aspects of Septic Complications and Urosepsis in Patients With Urological Disease Before and After Renal Transplantation: A Modern View on the Problem

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