Urinary tract infections and bladder dysfunction after renal transplantation in children.
OBJECTIVE
Urinary tract infection remains a major cause of morbidity in pediatric renal transplant recipients. In otherwise healthy children bladder dysfunction increases the susceptibility to urinary tract infection. The aims of this study were to determine whether bladder dysfunction affects the incidence of urinary tract infection after renal transplantation, and to assess the impact of recurrent urinary tract infections on graft function.


METHODS
We evaluated bladder function with a questionnaire, uroflowmetry and bladder ultrasound, and renal function with clearance of inulin or iohexol (glomerular filtration rate) in 68 recipients of renal transplants 5 to 20 years old, at 1 to 15 years after transplantation, with and without recurrent urinary tract infections.


RESULTS
Bladder dysfunction was equally common in children with and without recurrent urinary tract infections (68% vs 74%, not significant). Therefore, it had no effect on the incidence of recurrent urinary tract infections. Graft function deteriorated at a faster rate in patients with recurrent urinary tract infections than in those without (mean glomerular filtration rate 45 vs 57 ml per minute per 1.73 m(2) at 4 years after transplantation, p=0.02).


CONCLUSIONS
Bladder dysfunction did not predispose patients to recurrent urinary tract infections. Graft function declined with time in all patients but the rate of deterioration was faster in the group with recurrent urinary tract infections.
Herthelius
Maria
M
Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Children's Hospital, Karolinska University Hospital, Huddinge, Stockholm, Sweden. maria.herthelius@ki.se
Oborn
Helena
H
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D012008:Recurrence; D001745:Urinary Bladder Diseases / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D014563:Urodynamics