From the Guidelines
Urethritis in renal transplant patients is primarily caused by urinary tract infections (UTIs), which can lead to severe complications such as graft loss and acute graft rejection.
Causes of Urethritis
- UTIs are the most frequent infection identified in renal transplant patients, with unique outcomes of concern including graft loss, acute graft rejection, and impaired long-term graft function 1
- Risk factors for acquisition of asymptomatic bacteriuria (ASB) and symptomatic UTI include female sex, comorbidities, urologic variables, and some immunosuppressive therapies 1
Management of Urethritis
- Prophylactic antimicrobial therapy with trimethoprim-sulfamethoxazole (TMP-SMX) is recommended for at least 6 months after transplantation to prevent UTIs 1
- Treatment of ASB in renal transplant recipients more than 1 month after surgery may not prevent pyelonephritis or graft rejection, and probably does not improve graft function 1
- Routine treatment of ASB in kidney transplant recipients should be avoided after the first 2 months from transplantation, as it increases colonization with resistant organisms without providing clear benefit 1
- For allograft pyelonephritis, initial hospitalization and treatment with intravenous antibiotics is suggested 1
- Antimicrobial-resistant organisms are common in renal transplant recipients, and treatment of ASB probably promotes reinfection with organisms increasingly resistant to antimicrobials 1
From the Research
Causes of Urethritis in Kidney Transplant Patients
- Urethritis in kidney transplant patients can be caused by urinary tract infections (UTIs) 2, 3, which are the most common infection after kidney transplantation.
- UTIs can be asymptomatic due to immunosuppressive therapy, but can progress to acute pyelonephritis, bacteremia, and urosepsis 2.
- Urethral stricture can also occur after kidney transplantation, with causes including cystoscope-related iatrogenic injury and urinary tract infection 4.
- Urological complications such as urine leakage, ureteral stenosis, and vesicoureteral reflux can also contribute to urethritis in kidney transplant patients 5.
Management of Urethritis in Kidney Transplant Patients
- Conservative treatment, including Foley catheter and/or suprapubic cystostomy, can be effective in resolving urethritis and its complications 6.
- Antibiotics can be used to prevent recurrent infections, but their use should be carefully evaluated to avoid side effects and emergence of antibiotic-resistant microorganisms 3.
- Urethral dilation, internal urethrotomy, and urethra reconstruction surgery are treatment options for urethral stricture after kidney transplantation 4.
- Early identification of structural or functional urological abnormalities is crucial for successful management of recurrent urinary tract infections in kidney transplant patients 3.
- Advances in endourologic interventions have improved the management of urological complications after kidney transplantation 5.