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Febrile urinary tract infection after pediatric kidney transplantation: a multicenter, prospective observational study

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Abstract

Background

Febrile urinary tract infections (fUTIs) are common after kidney transplantation (KTx); however, prospective data in a multicenter pediatric cohort are lacking. We designed a prospective registry to record data on fUTI before and after pediatric KTx.

Methods

Ninety-eight children (58 boys and 40 girls) ≤ 18 years from 14 mid-European centers received a kidney transplant and completed a 2-year follow-up.

Results

Posttransplant, 38.7 % of patients had at least one fUTI compared with 21.4 % before KTx (p = 0.002). Before KTx, fUTI was more frequent in patients with congenital anomalies of kidneys and urinary tract (CAKUT) vs. patients without (38 % vs. 12 %; p = 0.005). After KTx, fUTI were equally frequent in both groups (48.7 % vs. 32.2 %; p = 0.14). First fUTI posttransplant occurred earlier in boys compared with girls: median range 4 vs. 13.5 years (p = 0.002). Graft function worsened (p < 0.001) during fUTI, but no difference was recorded after 2 years. At least one recurrence of fUTI was encountered in 58 %.

Conclusion

This prospective study confirms a high incidence of fUTI after pediatric KTx, which is not restricted to patients with CAKUT; fUTIs have a negative impact on graft function during the infectious episode but not on 2-year graft outcome.

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Abbreviations

AR:

Acute rejection

CAKUT:

Congenital anomalies of the kidney and urinary tract

CRP:

C-reactive protein

DMSA:

Technetium-99m dimercaptosuccinic acid

ESRD:

End-stage renal disease

eGFR:

Estimated glomerular filtration rate

fUTI:

Febrile urinary tract infection

GPN:

Gesellschaft für Pädiatrische Nephrologie

KTx:

Kidney transplantation

SCr:

Serum creatinine

VUR:

Vesicoureteral reflux

VCUG:

Voiding cystourethrography

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Acknowledgments

This study was supported by the German Society of Pediatric Nephrology (GPN).

Author information

Author notes

    Authors and Affiliations

    1. Pediatric Nephrology, University Medical Center Jena, Kochstrasse 2, 07743, Jena, Germany

      Friederike Weigel & Ulrike John

    2. Pediatric Nephrology, University Childrens Hospital, University Medical Center Hamburg Eppendorf, Hamburg, Germany

      Anja Lemke & Markus J. Kemper

    3. Department of Pediatrics I, University Children’s Hospital, Heidelberg, Germany

      Burkhard Tönshoff

    4. Pediatric Nephrology, Hannover Medical School, Hannover, Germany

      Lars Pape

    5. Children’s Hospital Memmingen, Memmingen, Germany

      Henry Fehrenbach

    6. Pediatric Nephrology, Children’s Hospital St. Georg, Leipzig, Germany

      Michael Henn

    7. Pediatric Nephrology, University Medical Center Bonn, Bonn, Germany

      Bernd Hoppe

    8. Department of Pediatrics I, University Medical Center Innsbruck, Innsbruck, Austria

      Therese Jungraithmayr

    9. Pediatric Nephrology, University Medical Center Münster, Münster, Germany

      Martin Konrad

    10. Department of Nephrology, University Children’s Hospital, Zurich, Switzerland

      Guido Laube

    11. Pediatric Nephrology, University Children’s Hospital, Freiburg, Germany

      Martin Pohl

    12. 2nd School of Medicine, University Hospital Motol, Charles University Prague, Prague, Czech Republic

      Tomáš Seeman

    13. Pediatric Nephrology, University Children’s Hospital, Rostock, Germany

      Hagen Staude

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    1. Friederike Weigel
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    Corresponding author

    Correspondence to Friederike Weigel.

    Ethics declarations

    The study was conducted according to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of the Friedrich-Schiller-University Jena and the respective Ethics Committees of each contributing center. All patients were enrolled at time of listing for Eurotransplant after parental informed consent.

    Conflict of interests

    The authors declare there are no conflicts.

    Additional information

    Friederike Weigel and Anja Lehnhardt contributed equally to this work.

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    Weigel, F., Lemke, A., Tönshoff, B. et al. Febrile urinary tract infection after pediatric kidney transplantation: a multicenter, prospective observational study. Pediatr Nephrol 31, 1021–1028 (2016). https://doi.org/10.1007/s00467-015-3292-2

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    • DOI: https://doi.org/10.1007/s00467-015-3292-2

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