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Dysfunction Of Lower Urinary Tract In Renal Transplant Children With Nephrologic Disease

UroToday.com - Bladder dysfunction is known to play a role in the upper urinary tract. As an example, we see a spectrum of entities from hydronephrosis with bladder holding in the dysfunctional voider to renal deterioration with prolonged bladder outlet obstruction as seen with untreated posterior urethral valves Van der Weide et al investigated the relationship between bladder dysfunction and its impact on renal transplant function in children after transplantation. They researched 21 renal transplant children (12 girls and 9 boys, mean age 13.5 years, range 6 to 18) that had an underlying nephrologic disease. The calculated creatinine clearance rate (Ccr) according to Schwartz was used to calculate renal function. The Ccr was measured at two points: 1) 2 months after transplantation and 2) at the time of the study. The average graft age was 34 months (range 5 to 85). The data on dysfunction of the lower urinary tract was acquired using a written questionnaire, voiding diaries, uroflowmetry, transabdominal ultrasonography, and medical records.

The group found that 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 when they performed a regression analysis. The group concluded 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. The power of the study is low just from the sheer numbers of pediatric renal transplant patients; however, this is a very interesting observation that makes sense. Dysfunctional voiding is a known risk factor for the development of urinary tract infections, which may be a risk factor for progression to pyelonephritis, a potential cause of renal scarring. If treatment of dysfunctional voiding plays a role in maintaining a healthy urinary tract, it may be crucial in the immunocompromised patients with delicate renal function.

By Pasquale Casale, MD

Reference:
Urology 67(5): 1060-1065, May 2006.
Link Here.

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Disfuncþii ale tractului urinar inferior În copii cu transplant renal Nephrologic Bolilor - Dysfunction Of Lower Urinary Tract In Renal Transplant Children With Nephrologic Disease - articole medicale engleza - startsanatate