Reflujo vesicoureteral sintom&aacute;tico posterior al injerto renal en adultos: tratamiento endourol&oacute;gico y reacci&oacute;n con agentes bloqueantes  <span class="so-article-trans-title" dir="auto"> Translated title: Symptomatic vesicoureteral reflux after kidney graft in adults: endourological management with blocking agents and their results </span>

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Abstract

Resumen El reflujo vesicoureteral después del trasplante renal es una complicación común, que puede favorecer la aparición de infección de vías urinarias recurrente y cuadros de pielonefritis aguda en el injerto, lo que incrementa el riesgo de su pérdida. Por consenso general, los pacientes con reflujo vesicoureteral sintomático deben recibir tratamiento. El tratamiento endourológico ha demostrado curar el reflujo y disminuir el índice de infección de vías urinarias y pielonefritis con pocas complicaciones. En las últimas décadas se han prescrito diferentes fármacos e implementado diversas técnicas para el tratamiento del reflujo vesicoureteral sintomático posterior al trasplante renal. Este artículo revisa las diferentes técnicas utilizadas y analiza la eficacia de los distintos fármacos prescritos para el reflujo vesicoureteral sintomático posterior al trasplante renal en adultos.

Translated abstract

Abstract Vesicoureteral reflux after kidney transplant is a common complication and can favor recurrent urinary tract infection and acute pyelonephritis in the graft, increasing the risk for graft loss. The general consensus is that symptomatic vesicoureteral reflux should be resolved. Endourologic management is recommended because it has shown reflux resolution, a reduced rate of urinary tract infections, and pyelonephritis with few complications. Over past decades, a variety of agents and procedures have been used for managing symptomatic vesicoureteral reflux after kidney transplantation. The present article reviews the characteristics of the different techniques utilized and analyzes the efficacy of the different products employed for the endoscopic resolution of symptomatic vesicoureteral reflux after kidney transplantation in adults.

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Most cited references 33

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The modified sting procedure to correct vesicoureteral reflux: improved results with submucosal implantation within the intramural ureter.

ANDREW KIRSCH, MARCOS PEREZ-BRAYFIELD, EDWIN SMITH … (2004)

With the advent of tissue bulking agents, in particular dextranomer/hyaluronic acid copolymer (Dx/HA), for endoscopic implantation for vesicoureteral reflux (VUR), there has been a major shift in the surgical paradigm throughout Europe, and more recently, in the United States. We describe a modification of the technique used for implantation that has significantly improved our results. Between October 2001 and October 2003, 285 children 7 months to 15 years old (mean age 4.6 years) underwent endoscopic implantation of Dx/HA for VUR at our institutions. A modified STING (subureteral transurethral injection) procedure (implantation submucosally within the intramural ureter) was introduced during the last year of the study. The average volume of injected material was measured for each ureter. Renal sonography was performed to determine if hydronephrosis was present. At 3 months flouroscopic voiding cystourethrograms were used to evaluate for the presence of VUR. A subset of 122 patients treated with STING (52) were compared to those treated with modified STING (70). A total of 459 ureters in 231 girls and 54 boys were treated (174 bilateral cases). Mean maximum grade per patient was 2.5/5. Mean injected volume was 0.9 cc ureter. There were 181 patients with at least 3 months of followup. After 1 treatment 76% (137 of 181) of cases were cured (grade 0 reflux), while 54% (24 of 44) of the failures were improved. The overall cure rate was 94% for grade I, 85% for grade II, 78% for grade III and 71% for grade IV reflux. The patients treated with STING had a mean age of 4.8 years, mean maximum reflux grade was 2.5 and success rate was 71% (37 of 52; 86% grade I, 89% grade II, 70% grade III and 63% grade IV reflux). The patients treated with a modified STING had a mean age of 5.5 years, mean maximum grade was 2.8 and a success rate was 89% (62 of 70; 100% grade I, 92% grade II, 91% grade III and 90% grade IV reflux). Ureteral success rates were significantly (p <0.01) greater for the modified STING (92%) vs the standard STING (79%). There were no cases of hydronephrosis at 3 months postoperatively. The majority of patients undergoing minimally invasive therapy for VUR with Dx/HA are cured after 1 treatment. The modified STING is our preferred method of implant injection for the correction of VUR and in our hands produces a resolution rate of 89% (92% of ureters). The technique optimizes ureteral coaptation, is easy to perform and is not associated with any significant short-term complications. Persistence of VUR in a minority of patients continues to be the only significant adverse effect of endoscopic implantation.

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Acute pyelonephritis represents a risk factor impairing long-term kidney graft function.

E Rondeau, C Chassin, Karell Pelle … (2007)

Urinary tract infections (UTIs) and acute pyelonephritis (APN) often occur after renal transplantation, but their impact on graft outcome is unclear. One hundred and seventy-seven consecutive renal transplantations were investigated to evaluate the impact of UTIs and APN on graft function. The cumulative incidence of UTIs was 75.1% and that of APN was 18.7%. UTIs occurred mainly during the first year after transplantation and Escherichia coli, Pseudomonas aeruginosa and Enteroccocus sp. were the most frequent pathogens identified. The risk of developing APN was higher in female (64%) than in male recipients, and was correlated with the frequency of recurrent UTIs (p < 0.0001) and rejection episodes (p = 0.0003). APN did not alter graft or recipient survival, however, compared to patients with uncomplicated UTIs, patients with APN exhibited both a significant increase in serum creatinine and a decrease in creatinine clearance, already detected after 1 year (aMDRD-GFR: APN: 39.5 +/- 12.5; uncomplicated UTI: 54.6 +/- 21.7 mL/min/1.73 m(2), p < 0.01) and still persistent ( approximately - 50%) 4 years after transplantation. Multivariate analysis revealed that APN represents an independent risk factor associated with the decline of renal function (p = 0.034). Therefore, APN may be associated with an enduring decrease in renal graft function.

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Late urinary tract infection after renal transplantation in the United States.

R N Lipnick, Maurice Swanson, D Cruess … (2004)

Although urinary tract infection (UTI) occurring late after renal transplantation has been considered "benign," this has not been confirmed in a national population of renal transplant recipients. We conducted a retrospective cohort study of 28,942 Medicare primary renal transplant recipients in the United States Renal Data System (USRDS) database from January 1, 1996, through July 31, 2000, assessing Medicare claims for UTI occurring later than 6 months after transplantation based on International Classification of Diseases, 9th Revision (ICD-9), codes and using Cox regression to calculate adjusted hazard ratios (AHRs) for time to death and graft loss (censored for death), respectively. The cumulative incidence of UTI during the first 6 months after renal transplantation was 17% (equivalent for both men and women), and at 3 years was 60% for women and 47% for men (P < 0.001 in Cox regression analysis). Late UTI was significantly associated with an increased risk of subsequent death in Cox regression analysis (P < 0.001; AHR, 2.93; 95% confidence interval [CI], 2.22, 3.85); and AHR for graft loss was 1.85 (95% CI, 1.29, 2.64). The association of UTI with death persisted after adjusting for cardiac and other infectious complications, and regardless of whether UTI was assessed as a composite of outpatient/inpatient claims, primary hospitalized UTI, or solely outpatient UTI. Whether due to a direct effect or as a marker for serious underlying illness, UTI occurring late after renal transplantation, as coded by clinicians in the United States, does not portend a benign outcome.

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Author and article information

Journal

Journal ID (publisher-id): rmu

Title: Revista mexicana de urología

Abbreviated Title: Rev. mex. urol.

Publisher: Sociedad Mexicana de Urología (Ciudad de México, Ciudad de México, Mexico )

ISSN (Print): 0185-4542

ISSN (Electronic): 2007-4085

Publication date (Print and electronic): October 2017

Volume: 77

Issue: 5

Pages: 419-424

Affiliations

[1] orgnameInstituto Mexicano del Seguro Social orgdiv1Centro Médico Nacional Adolfo Ruiz Cortines Mexico

[2] orgnameUniversidad Veracruzana orgdiv1Facultad de Medicina Miguel Alemán Valdés Mexico

Article

Publisher ID: S2007-40852017000500419 Publisher ID: S2007-4085(17)07700500419

DOI: 10.24245/revmexurol.v77i5.1371

SO-VID: dd562fd9-29a2-4cf5-af50-b44f16ba4f2b

License:

This work is licensed under a Creative Commons Attribution 4.0 International License.

History

Date accepted : August 2017

Date received : March 2017

Page count

Figures: 0, Tables: 0, Equations: 0, References: 33, Pages: 6

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SciELO Mexico

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Reflujo vesicoureteral sintomático posterior al injerto renal en adultos: tratamiento endourológico y reacción con agentes bloqueantes Translated title: Symptomatic vesicoureteral reflux after kidney graft in adults: endourological management with blocking agents and their results

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