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NDT Advance Access published online on September 8, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl464
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received April 18, 2006
Accepted July 7, 2006

Original Article

High prevalence of febrile urinary tract infections after paediatric renal transplantation

Ulrike John 1 *, Anne Schulze Everding 2, Eberhard Kuwertz-Bröking 2, Monika Bulla 2, Dirk E. Müller-Wiefel 3, Joachim Misselwitz 1, and Markus J. Kemper 3

1 Pediatric Nephrology, Friedrich Schiller University Children's Hospital, Kochstraße 2, D-07740 Jena, Germany
2 Pediatric Nephrology, University Children's Hospital, Albert-Schweitzer-Straße 22, D-48149 Münster, Germany
3 Pediatric Nephrology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany

* To whom correspondence should be addressed.
Ulrike John, E-mail: ulrike.john{at}med.uni-jena.de



  Abstract

Background. Adult data suggest that urinary tract infections occur frequently after renal transplantation (RTx) and contribute to mortality and graft loss; data in children are limited. Therefore, we evaluated prevalence, short and long-term morbidity and confounding factors of febrile UTI (fUTI) after paediatric RTx.

Methods. In a retrospective cross-sectional study of three centres, we analysed data on 110 children followed for 4.9 ± 3.4 years after successful transplantation.

Results. 40/110 (36%) patients had at least one fUTI at a median time of 0.98 years (range 0.02-8.96) after RTx; 11 patients (28%) had recurrent fUTI. Serum creatinine (SCr) rose significantly from 1.15 ± 1.13 to 1.83 ± 1.69 mg/dl, (P < 0.001) during the fUTI, declining to baseline values after treatment. At the last followed-up calculated mean, GFR was comparable between fUTI and non-fUTI groups (75 ± 26 vs 71 ± 22 ml/min/1.73 m2). During fUTI mean, C-reactive protein (CRP) increased to 123 ± 75 mg/l. Febrile UTI were significantly more frequent in girls compared to boys (22/44 vs 18/66, P < 0.05) but occurred significantly earlier in boys than in girls [median 0.63 (range 0.02-4.15) vs 1.07 (0.04-8.96) years after RTx; P < 0.02]. Also, patients with urinary tract malformations (UTMs) and neurogenic bladder as underlying diagnosis and those with urological surgery prior to transplantation had an increased risk for fUTI.

Conclusion. fUTI is a frequent complication with significant short-term morbidity especially in girls and children with UTMs, neurogenic bladder and those with urological surgery. Long-term follow-up and prospective studies confirming specific risk factors, preventive measures and impact on graft survival are necessary.

Keywords: congenital urinary tract malformation; paediatric renal transplantation; risk factor; urinary tract infection.
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