Dysfunction of lower urinary tract in renal transplant children with nephrologic disease

doi:10.1016/j.urology.2005.11.065

Urology

Volume 67, Issue 5, May 2006, Pages 1060-1065

https://doi.org/10.1016/j.urology.2005.11.065 Get rights and content

Abstract

Objectives

To investigate the relationship between dysfunction of the lower urinary tract after renal transplantation and renal transplant function in children with an underlying nephrologic disease.

Methods

The research group consisted of 21 renal transplant children (12 girls and 9 boys, mean age 13.5 years, range 6 to 18) with an underlying nephrologic disease. To indicate renal transplant function, the calculated creatinine clearance rate (Ccr) according to Schwartz was used. The Ccr was measured at two points, 2 months after transplantation and at the moment of study. The average graft age was 34 months (range 5 to 85). The data on dysfunction of the lower urinary tract were gathered using a written questionnaire, frequency volume chart, free uroflowmetry, transabdominal ultrasonography, and medical records. To determine the relationship between the symptoms of dysfunction of the lower urinary tract and Ccr at the moment of study, we computed bivariate correlations and performed multivariate regression analyses in which the associations were studied while controlling for the Ccr 2 months after transplantation and graft age.

Results

A sensation of incomplete emptying (P = 0.03), postvoid residual urine volume (P = 0.06), and urinary tract infection (P = 0.004) correlated negatively with the Ccr at the moment of study. These effects remained present (P = 0.07, P = 0.03, and P = 0.003, respectively) while controlling for graft age and the Ccr at 2 months after transplantation in the regression analysis.

Conclusions

The results of our study have shown that a postvoid residual urine volume and urinary tract infections after renal transplantation may result in renal transplant deterioration in children with an underlying nephrologic disease.

Section snippets

Material and methods

With permission of the Medical Ethics Committee of Radboud University Nijmegen, data were gathered from January to May 2003 using a written questionnaire, free uroflowmetry, transabdominal ultrasonography, frequency volume chart, and the children’s medical records. The questionnaire we used was based on the Bristol Female Lower Urinary Tract Symptoms questionnaire.11, 13 In this instrument, LUTS are defined from the patient’s perspective. The patient or the caregiver can describe the symptoms.

Characteristics

Table I shows the characteristics of the study group (n = 21). Eight children underwent bilateral nephrectomy and one unilateral nephrectomy. Three children underwent preemptive transplantation and therefore did not need renal replacement therapy. Eight children underwent peritoneal dialysis and 10 children hemodialysis before renal transplantation. Five children received their transplant from a living, related donor and 16 children from a postmortem donor. The mean age at transplantation was

Comment

We studied the effects of dysfunction of the lower urinary tract on transplant function in renal transplant children with an underlying nephrologic disease. We found substantial negative relationships between the Ccr at study and PVR urine volume, sensation of incomplete emptying, and UTI. To determine whether these associations were not just an effect of graft age or an initial low Ccr, OLS regression analyses were performed. Our results have made clear that both PVR urine volume (P = 0.03)

Conclusions

A PVR urine volume and UTIs after renal transplantation may result in renal transplant deterioration in children with an underlying nephrologic disease.

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Citation Excerpt :
In children with nonurological disorders we found a surprisingly high frequency of LUTS (59%), which to our knowledge has not been reported previously. Since LUTS may be a risk factor for UTI after transplantation, and recurrent UTIs constitute a risk of deterioration of graft function, LUTS should be recognized as an important variable in all pre-transplant investigations, not just in children with urological disorders.5,6 In the nonurological disorders group 10 of 27 patients (37%) had a large bladder capacity.
Lower urinary tract symptoms are common in children after renal transplantation. However, it is unclear whether lower urinary tract symptoms are present before transplantation or appear postoperatively. We sought to evaluate bladder function in children before renal transplantation.
A total of 40 children 5 to 18 years old with a glomerular filtration rate of less than 50 ml per minute per 1.73 m² were consecutively enrolled in the study from 2006 to 2008. Bladder function was assessed by a comprehensive history, bladder diary, uroflowmetry and bladder ultrasound.
Of the patients 20% suffered from incontinence, 47.5% had bladder capacity larger than expected for age, 20% had discontinuous flow and 15% had residual urine 20 ml or greater. Signs consistent with bladder dysfunction (incontinence, abnormal bladder capacity, discontinuous urinary flow and/or residual urine) were observed in 13 of 13 children (100%) with urological disorders and 16 of 27 (59%) with nonurological disorders. Polyuria was present in 39% of the patients. Prior febrile urinary tract infection was significantly more common in children with vs without signs of bladder dysfunction.
Lower urinary tract symptoms are common in children with chronic renal failure. Screening for bladder dysfunction is important not only in children with urological disorders, but also in those with nonurological disorders, so that dysfunction can be corrected before transplantation.
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Pediatric urologyDysfunction of lower urinary tract in renal transplant children with nephrologic disease

Abstract

Objectives

Methods

Results

Conclusions

Section snippets

Material and methods

Characteristics

Comment

Conclusions

J Urol

J Urol

J Urol

Transplant Proc

J Urol

J Urol

J Urol

Kidney Int

J Urol

Long-term outcome of boys with posterior urethral valves

Br J Urol

Long term results of pediatric renal transplantation into a dysfunctional lower urinary tract

Transplantation

Urinary tract infection in patients with urological complications after renal transplantation with respect to long-term function and allograft survival

Ann Transplant

Pediatric urology
Dysfunction of lower urinary tract in renal transplant children with nephrologic disease