Renal Transplants Due to Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) Have Better Graft Survival Than Non-CAKUT Controls: Analysis of Over 10,000 Patients

Cornwell, Laura B.; Ingulli, Elizabeth; Mason, Matthew D.; Ewing, Emily; Riddell, Jonathan

doi:10.1016/j.urology.2021.01.005

Cited by 8 publications

(4 citation statements)

References 23 publications

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“…Individuals with CAKUT represent 29-40% of pediatric ESRD and include aplasia/hypoplasia/ dysplasia, medullary cystic disease, multicystic-dysplastic kidney, neurogenic bladder, obstructive uropathy, reflux nephropathy, and vesicoureteral reflux (VUR) [27,28]. Over the years, research has demonstrated no significant difference in long-term graft survivability for patients with CAKUT, including those who have undergone urinary tract reconstruction [29][30][31][32]. However, this is in part due to a thorough pre-transplant evaluation that ensures the graft is being transplanted into a low pressure LUT system that empties efficiently [33].…”

Section: Urologic Etiologies Of Esrdmentioning

confidence: 99%

Urodynamics in the Transplant Population

Lee,

Van Kuiken

2024

Curr Bladder Dysfunct Rep

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Purpose of Review Urodynamic testing (UDS) is a valuable tool for understanding the safety of the lower urinary tract (LUT). The goal of this review is to provide evidence-based indications for use of UDS in both the pre-and post-kidney transplant (KT) settings. Recent Findings Pre-transplant bladder cycling with UDS for anuric or oliguric patients is no longer recommended. Instead, UDS aids in identifying LUT anomalies that may require optimization prior to transplant, especially in patients with known urologic etiologies of end-stage renal disease (ERSD). In pre-KT patients with recurrent urinary tract infections (UTIs) or prior urologic/pelvic interventions, UDS should be used judiciously when the etiology of LUT dysfunction is unclear. In the post-transplant setting, urologists are often consulted for LUT symptoms (LUTS), hydronephrosis, urinary retention, declining renal function, and most commonly, recurrent UTI. Again, UDS should not be routinely performed first line, but as an adjunct to distinguish similarly presenting LUT etiologies such as bladder outlet obstruction (BOO) and bladder dysfunction. Summary UDS remains the gold standard for characterizing the LUT, and when utilized appropriately, can identify factors promoting graft and patient survival after KT.

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Section: Urologic Etiologies Of Esrdmentioning

confidence: 99%

Urodynamics in the Transplant Population

Lee,

Van Kuiken

2024

Curr Bladder Dysfunct Rep

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“…However, among CAKUT patients, PUV patients were shown to perform worse [ 82 , 83 , 84 ]; this was possibly due to the bladder comorbidity, which might not ensure low-pressure storage and complete emptying. By contrast, in a newer cohort with lower urinary tract malformations, patients did not perform worse than patients with upper urinary tract malformations [ 85 ]. This might be due to the better care received for bladder dysfunction.…”

Section: Management Of Chronic Kidney Disease In Posterior Urethral V...mentioning

confidence: 99%

Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management

Klaus

Lange-Sperandio

2022

Biomedicines

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Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dl implies a very low risk for ESKD, whereas a value above 0.85 mg/dl indicates beneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival.

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“…While endoscopic subureteric injections of dextranomer/hyaluronic acid may be considered, success rates in correcting post-Tx VUR have been low, and their use has been associated with many complications. 71,73 POSTTRANSPLANT OUTCOMES When comparing outcomes in children with and without urologic causes of ESRD, most studies have shown comparable graft or patient survival in children with CA-KUT, 74 in spite of higher risk of post-Tx UTIs, even in the presence of severe bladder dysfunction. 75,76 Therefore, for pediatric patients with advanced CKD and ESRD due to CAKUT, Tx is the goal for renal replacement therapy because of the better long-term survival, growth and development, and quality of life after Tx than remaining on maintenance dialysis.…”

Section: Managing Bladder Dysfunctionmentioning

confidence: 99%