Vesicoureteral Reflux After Kidney Transplantation: Clinical Significance in the Medium to Long-Term

Vianello, A.; Pignata, Giulia; Caldato, C; Falco, Giuseppe; Calconi, G; Fandella, A.; Rabassini, A; Maresca, M. C.

doi:10.1016/s0022-5347(01)63331-7

Cited by 8 publications

(12 citation statements)

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“…It is therefore likely that DMSA scans will be the most-sensitive method of detecting allograft scars. None of the studies of transplant patients known to have vesicoureteric reflux has used either intravenous urography or DMSA scans [1,2,3,4,5,6,7,8,11] until now. One study of adult allograft recipients identified two or three segmental cortical defects in the grafts of all three patients in their series who had a clinical history of acute pyelonephritis, but speculated that these localised lesions may have arisen from other conditions, including acute rejection and cyclosporin toxicity [21].…”

Section: Discussionmentioning

confidence: 99%

“…Vesicoureteric reflux into renal allografts is common whether simple ureteroneocystotomies or anti-reflux anastamoses are used [1,2,3,4,5,6,7]. Avoidance of early leakage and late obstruction has been a greater consideration than prevention of reflux when ureteric anastamoses are fashioned [3,6,7].…”

Section: Introductionmentioning

confidence: 99%

“…Avoidance of early leakage and late obstruction has been a greater consideration than prevention of reflux when ureteric anastamoses are fashioned [3,6,7]. Although there has been dispute whether vesicoureteric reflux into a transplanted kidney increases the risk of urine infection [3,5,7] or pyelonephritis [7,8,9], and whether it leads to hypertension [2] or loss of graft function [1,3,4,5,6,7], little attention has been paid to the possibility that grafts with reflux may develop areas of inflammation or scarring with urine infection, i.e., reflux nephropathy, in the same way as the kidneys of young children [10]. Studies of reflux in allografts have been designed to look for changes in overall kidney function rather than for scars.…”

Section: Introductionmentioning

confidence: 99%

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Reflux nephropathy in transplants

2002

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Reflux nephropathy, renal scarring after urine infection, typically occurs in infancy. Although vesicoureteric reflux occurs commonly in kidney allografts, grafts have not previously been regarded as likely to be affected by reflux nephropathy, perhaps because older kidneys are considered to have matured out of the risk. Evidence that adult pigs remain at risk of reflux nephropathy challenges that assumption. We therefore reviewed the pathological findings in allograft nephrectomy specimens to look for evidence of reflux nephropathy, and sought evidence of focal transplant renal scarring in paediatric recipients who had a urine infection and vesicoureteric reflux. Consecutive allograft nephrectomy specimens (146) that had been removed between 1990 and 1999 were examined for evidence of reflux nephropathy, and relevant case notes were reviewed. Also, children with a renal transplant who had a urine infection were investigated for focal scarring by dimercaptosuccinic acid (DMSA) scanning and for reflux with a cystogram. Four transplanted kidneys from adult donors that were removed from adult recipients had developed changes consistent with reflux nephropathy. Of these, 3 also had definite evidence and 1 probable evidence of a glomerulopathy associated with hyperfiltration due to reduced renal mass. All 4 patients had had recurrent urine infection and the 2 assessed had had vesicoureteric reflux. Two children with renal transplants that also had urine infections and vesicoureteric reflux to their graft were shown to have sustained focal damage on DMSA scan, confirmed as reflux nephropathy scarring on biopsy in 1 case. The grafts were aged 14.4 years and over 16 years at the time of scarring. Reflux nephropathy can occur in previously healthy adult human kidneys after transplantation. Previous studies of the effect of vesicoureteric reflux on renal allografts were not designed to assess the possibility of mild or focal scarring.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reflux nephropathy in transplants

2002

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“…Neoplastic obstruction in transplants is also extremely rare [6]. Vesicoureteral reflux (VUR) must be considered as another cause of graft hydronephrosis [7].…”

Section: Introductionmentioning

confidence: 99%

Imaging in ureteral complications of renal transplantation: value of static fluid MR urography

et al. 2000

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Ureteral obstruction is an infrequent complication after renal transplantation that may cause rapid loss of transplant function. We tested static fluid MR urography for determining the cause of graft hydronephrosis. Magnetic resonance urography was performed in nine transplants with dilated collecting systems on ultrasound. A heavily T2-weighted 3D turbo spin-echo sequence on a 1.5-T scanner was used and maximum intensity projections were obtained. The patients also underwent excretory urography (n = 1), renal scintigraphy (n = 1), antegrade pyelography (n = 3), voiding cystourethrography (n = 4), and non-enhanced CT (n = 2). Six patients had pathologic conditions including ureteral stricture, compression by lymphoceles, implantation stenosis, vesicoureteral reflux, and late-occurring transitional cell carcinoma at the implantation site. Static MRU was able to diagnose or exclude a dilation of the graft collecting system. It visualized the course of the ureters and localized the obstruction site in four of five obstructed transplants. In one case the ureter was obscured by lymphoceles, which were demonstrated by hydrographic MRU as well. The definite cause for obstruction was provided in only 2 of 5 cases. Dilation due to vesicoureteral reflux could not be differentiated. The current multimodality approach to renal transplant imaging already provides comprehensive assessment of graft hydronephrosis. Static MRU may be useful in some cases since complications associated with intravenous iodinated contrast or antegrade pyelography can be avoided. Its main drawback, the lack of functional information, may be overcome by combining it with contrast-enhanced MRU.

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“…Studies of children with vesicoureteric reflux (VUR) have suggested that, for native kidneys at least, scarring due to urinary tract infection rarely occurs beyond the age of 5 years (9). Adult kidneys have thus been considered largely unsusceptible to scarring (9,10). As a consequence, recurrent urinary tract infections have not been generally accepted as a cause of late graft dysfunction (1,2,7,(11)(12)(13), although this assertion appears to be based on only a handful of small studies (1, 14 -16).…”

mentioning

confidence: 99%