Program Schedule

432
Pathologic Pyelonephritis In Kidney Transplant Recipients: Bacterial Infection?

Session: Poster Abstract Session: Transplant Infectious Diseases
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • SR_RenalTxpPyelo.pdf (89.9 kB)
  • Background: Pyelonephritis (pyelo) in renal transplant  recipients (RTxp) is usually treated with antibacterials. Non-bacterial causes such as viral pyelo exist, but histopathologic pyelo without clinical or laboratory features has not been studied.

    Methods: Our objective is to characterize RTxp with histopathologic pyelo but without the usual clinical or laboratory features of pyelo. We performed a retrospective chart review of RTxp admitted to Einstein Medical Center Philadelphia from 1/1/2002 to 6/30/2011 with a clinical or pathologic diagnosis of pyelo. Temperature, WBC count, serum creatinine, urine and blood cultures, duration of antibiotics and change in creatinine at discharge were compared. Patients were followed for 1 year to compare rates of readmission, repeat pyelo, rejection, and death. Fisher's exact test and Mann-Whitney test were used to analyze the data.

    Results:

    Table 1: Clinical and laboratory data                                    ns=not significant

     

    Path pyelo (n=6)

    Clinical pyelo (n=20)

    p value

    Urinary symptoms

    1*

    18

     

    Abdominal pain

    2*,#

    15

     

    Temperature (oC)

    <38

    38-39

     

    WBC (103/cmm)

    5.9 (4-8.3)

    9.7 (6.9 -13.2)

     

    Bacteriuria  

    1*

    20

     

    Bacteremia

    0

    5

     

    Antibiotic Rx

    5

    20

    ns

    Rx Duration (Week)

    1 (1-1)

    2  (2-2)

    ns

    # Endometriosis * Reflux nephropathy, urine with mixed skin flora (ns)

    6 patients were diagnosed with pyelo by pathologic criteria alone (Path pyelo) (Table 1). 20 patients with clinical pyelo were randomly selected as controls. Median admission creatinines in the two groups were 1.8 mg/dl and 3.3 mg/dl. The higher creatinine in the path pyelo group presumably prompted the renal biopsies (Fig 1). All biopsies were reviewed by 2 pathologists.

    The one patient without antibiotics had no recurrent pyelo or rejection. Both groups had similar rates of readmission and recurrent pyelo, suggesting an identical, i.e. bacterial, etiology in both groups (Fig 2). Overall prognosis was benign with only one rejection and no deaths.

    Conclusion: This is a small study with only 6 patients meeting the criteria for pathological pyelonephritis, but this is the first time this rare disease process has been studied. The data is suggestive of a bacterial etiology and benign prognosis, but larger studies are required to further characterize the disease and need for antibiotic therapy.

    Sushma Ramprasad, MD1, Kuan-Hsiang Huang, MD, PhD2 and Robert Fischer, MD1, (1)Infectious Diseases, Albert Einstein Medical Center, Philadelphia, PA, (2)Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA

    Disclosures:

    S. Ramprasad, None

    K. H. Huang, None

    R. Fischer, None

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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