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High prevalence of febrile urinary tract infections after paediatric renal transplantation.

John U, Everding AS, Kuwertz-Bröking E, Bulla M, Müller-Wiefel DE, Misselwitz J, Kemper MJ

Department of Pediatric Nephrology, University Children's Hospital, Kochstraße 2, D-07740 Jena, Germany. ulrike.john@med.uni-jena.de.

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 m(2)). 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.

Published 13 October 2006 in Nephrol Dial Transplant, 21(11): 3269-3274.
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