title: High prevalence of febrile urinary tract infections after paediatric renal transplantation.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Nephrology, Friedrich Schiller University Children's Hospital, Kochstrasse 2, D-07740 Jena, Germany. ulrike.john@med.uni-jena.de
authors.forename: Ulrike
authors.initials: U
authors.lastname: John
authors.forename: Anne Schulze
authors.initials: AS
authors.lastname: Everding
authors.forename: Eberhard
authors.initials: E
authors.lastname: Kuwertz-Bröking
authors.forename: Monika
authors.initials: M
authors.lastname: Bulla
authors.forename: Dirk E
authors.initials: DE
authors.lastname: Müller-Wiefel
authors.forename: Joachim
authors.initials: J
authors.lastname: Misselwitz
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Kemper
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D005334:Fever / Q000453:epidemiology*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D014551:Urinary Tract / Q000002:abnormalities; D014552:Urinary Tract Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology