Renal Transplantation in Children With Severe Lower Urinary Tract Dysfunction

Koo, Harry P.; Bunchman, Timothy E.; Flynn, Joseph T.; Punch, Jeffrey D.; Schwartz, Anne C.; Bloom, David A.

doi:10.1097/00005392-199901000-00078

Cited by 32 publications

(69 citation statements)

References 21 publications

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“…Alfrey et al reported that bladder augmentation before transplant caused increasing hydronephrosis and infection and sug- Values are given as mean ± standard error unless indicated otherwise gested takedown of bladder augmentation before transplant [20]. Other studies, however, have shown that urinary tract reconstruction before transplantation is safe [21][22][23]. Koo et al studied 18 patients with severe dysfunctional lower urinary tract anomalies that included posterior urethral valves, urogenital sinus anomalies, prune-belly syndrome, complete bladder duplication, and ureterocele [22].…”

Section: Discussionmentioning

confidence: 99%

“…Other studies, however, have shown that urinary tract reconstruction before transplantation is safe [21][22][23]. Koo et al studied 18 patients with severe dysfunctional lower urinary tract anomalies that included posterior urethral valves, urogenital sinus anomalies, prune-belly syndrome, complete bladder duplication, and ureterocele [22]. Eleven patients underwent bladder augmentation or continent urinary diversion, while two had an intestinal conduit and five had a transplant into the native bladder.…”

Section: Discussionmentioning

confidence: 99%

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Chronic kidney disease in the VACTERL association: clinical course and outcome

et al. 2009

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Approximately 60% of VACTERL (vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula with atresia, renal defects/radial limb dysplasia) patients have renal anomalies that can be associated with chronic kidney disease (CKD). With improved medical care, a large proportion of these patients survive into adulthood. Longitudinal follow-up data regarding the management of kidney disease in these children is lacking. Twelve VACTERL patients with CKD stage 2-5 and 12 age-matched controls with similar urologic anomalies and CKD [mean follow-up period 15.0 +/- 1.4 (SE) and 11.9 +/- 2.1 years, respectively] were identified in a single center. Eight VACTERL patients progressed to end-stage renal disease (ESRD) compared to four controls (66.7 vs. 33.3%, respectively). Six VACTERL patients were dialyzed pre-transplant. Of the four patients on peritoneal dialysis (PD), three had to be switched to hemodialysis due to complications, whereas two of the three controls on PD did not experience significant problems. Seven VACTERL patients underwent renal transplantation compared to four controls. Mean creatinine clearance 2 years post-transplant was 65.8 +/- 6.3 in VACTERL patients vs. 87.8 +/- 7.1 ml/min per 1.73 m(2) in controls (p = 0.03). VACTERL patients had a significantly lower mean height standard deviation score than the controls (-2.34 +/- 0.41 vs. -1.27 +/- 0.24, respectively; p < 0.05). Based on these results, VACTERL patients with CKD develop ESRD more frequently, experience more complications with dialysis, may have a poorer transplant outcome, and have more severe growth failure than controls.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chronic kidney disease in the VACTERL association: clinical course and outcome

et al. 2009

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“…Sometimes only a brief referral is given about these complications in publications about graft survival. A summary of complications in pediatric patients reported in the literature and our own series is given in table 1 [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12]. …”

Section: Discussionmentioning

confidence: 99%

“…Although rejection is the main cause of graft failure, urological complications can also play a role in graft loss and even patient mortality. The incidence of urological complications after kidney transplantation has been reported to range from 0 to 33% [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13], although data are not really comparable because some authors include only major urological complications, whereas others even include urinary tract infections. A higher rate of complications can be expected in children compared with adults, due to the higher number of patients with congenital urinary tract abnormalities often seen in combination with bladder dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Urological Complications in Pediatric Renal Transplantation

Nuininga¹,

Feitz²,

Dael³

et al. 2001

European Urology

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“…Symptoms of bladder dysfunction after renal transplantation have been reported in adults [10]. There are several reports on post-transplant patient and graft survival [11][12][13][14][15][16] and a few on bladder function [17,18] in children with dysfunctional urinary tract, but there are, to our knowledge, no reports on bladder function in post-transplant children with normal urinary tracts. We report here the incidence of bladder dysfunction in an unselected group of renal transplant recipients in the Children's Hospital at Karolinska University Hospital, Huddinge, Sweden.…”

Section: Introductionmentioning

confidence: 98%

Bladder dysfunction in children and adolescents after renal transplantation

Herthelius

Öborn

2006

Pediatr Nephrol

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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.

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Renal Transplantation in Children With Severe Lower Urinary Tract Dysfunction

Cited by 32 publications

References 21 publications

Chronic kidney disease in the VACTERL association: clinical course and outcome

Chronic kidney disease in the VACTERL association: clinical course and outcome

Urological Complications in Pediatric Renal Transplantation

Bladder dysfunction in children and adolescents after renal transplantation

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