Singh R, Geerlings S E, Peters-Sengers H, Idu M M, Hodiamont C J, Ten Berge I J M, Bemelman F J
Renal Transplant Unit, Division of Nephrology, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
Division of Infectious Diseases, Department of Internal Medicine, Academic Medical Center-University of Amsterdam, Amsterdam, The Netherlands.
Transpl Infect Dis. 2016 Oct;18(5):647-660. doi: 10.1111/tid.12568. Epub 2016 Sep 7.
The impact of allograft pyelonephritis (AGPN) on renal allograft function is controversial. In this study, we evaluated the incidence, risk factors, and the impact of AGPN on renal allograft function.
Retrospective cohort study in adult renal allograft recipients with 1-year follow-up after transplantation (Tx). Renal allograft function was evaluated by estimated glomerular filtration rate (eGFR) (by Modification of Diet in Renal Disease formula) and 24-h urine protein excretion.
A total of 431 renal allograft recipients were analyzed; 57 (13.2%) developed AGPN within 1 year after Tx. Median time between Tx and AGPN was 50 days. Risk factors for AGPN were the presence of a urological catheter (odds ratio [OR] = 18.93, 95% confidence interval [CI] = 8.00-44.81, P < 0.001) and preceding asymptomatic bacteriuria (ASB) (OR = 2.16, 95% CI = 1.20-3.90, P = 0.009). In 72.7%, the causative microorganism of ASB was identical to that of the succeeding AGPN episode. Multivariable linear regression analysis showed that experiencing AGPN did not decrease the eGFR (P = 0.61) nor did increased proteinuria (P = 0.29) 1 year after Tx. For the eGFR, an interaction was found between AGPN/bacteriuria (BU) and acute rejection (AR): the group experiencing BU preceding AR had significantly (P < 0.001) lower eGFR compared with the group that experienced only AR (21 mL/min/1.73 m vs. 48 mL/min/1.73 m ), as a result of increased prevalence of combined rejections within the BU group.
Indwelling urological catheters and preceding ASB are associated with developing AGPN. An incident of AGPN itself does not impair renal allograft function 1 year after Tx. However, a relevant interaction occurs between BU and AR, in which the sequence of occurrence of these 2 events synergistically impairs the eGFR.
同种异体移植肾盂肾炎（AGPN）对肾移植功能的影响存在争议。在本研究中，我们评估了AGPN的发病率、危险因素及其对肾移植功能的影响。
对成年肾移植受者进行回顾性队列研究，移植后（Tx）随访1年。通过估计肾小球滤过率（eGFR）（采用肾脏病饮食改良公式）和24小时尿蛋白排泄量评估肾移植功能。
共分析了431例肾移植受者；57例（13.2%）在Tx后1年内发生AGPN。Tx与AGPN之间的中位时间为50天。AGPN的危险因素包括存在导尿管（比值比[OR]=18.93，95%置信区间[CI]=8.00-44.81，P<0.001）和先前的无症状菌尿（ASB）（OR=2.16，95%CI=1.20-3.90，P=0.009）。在72.7%的病例中，ASB的致病微生物与随后AGPN发作的致病微生物相同。多变量线性回归分析显示，发生AGPN在Tx后1年既未降低eGFR（P=0.61），也未增加蛋白尿（P=0.29）。对于eGFR，发现AGPN/菌尿（BU）与急性排斥反应（AR）之间存在相互作用：与仅经历AR的组相比，在AR之前经历BU的组eGFR显著降低（P<0.001）（21 mL/min/1.73 m²对48 mL/min/1.73 m²），这是由于BU组内联合排斥反应的发生率增加所致。
留置导尿管和先前的ASB与AGPN的发生有关。AGPN事件本身在Tx后1年不会损害肾移植功能。然而，BU与AR之间存在相关相互作用，其中这两个事件的发生顺序协同损害eGFR。
