Severe renal failure in acute bacterial pyelonephritis: do not forget corticosteroids.

Acute renal failure (ARF) is a rare complication of acute pyelonephritis in adult immunocompetent patients. Recovery of renal function usually occurs if antibiotics are promptly initiated. However, long-term consequences of renal scarring due to acute pyelonephritis are probably underestimated, and some patients present with prolonged renal failure despite adequate antibiotic therapy. We report two cases of severe ARF complicating bacterial pyelonephritis successfully treated with corticosteroids in association with conventional antibiotics.

Urinary tract infections in renal allograft recipients from living related donors.

Urinary tract infection (UTI) remains the most common infectious complication in renal transplant recipients. We aimed in our study to describe the epidemiological patterns and evaluate the favouring factors of UTI in our renal allograft recipients. We evaluated retrospectively all the UTIs in 47 kidney recipients transplanted from living-related kidney donors in Rabat University Hospital, Morocco, from January 1998 to December 2005. The mean follow-up was 28+/-19 months. The mean age of the patients was 32+/-10 years with a male/female ratio of 1.35/1. Twenty patients (42%) suffered at least one UTI episode. UTIs were asymptomatic in 70% of the patients, while manifested as acute pyelonephritis in 17% and uncomplicated acute bacterial cystitis in 13%. UTI episodes occurred in 68% of the patients during the first 3 months post-kidney transplantation with a recurrence rate of 55%, and all the patients experienced a favourable course. Gram-negative bacilli were the principally isolated agents; E. Coli was found in 60% of the patients and Klebsiella in 30%. UTI was more common in females (p=0.04) and cases of post transplantation vesicoureteral reflux (p=0.03). The graft survival rate at the end of the study was comparable for both UTI and non-UTI groups.

Hypertension in related living donor renal allograft recipients.

Cardiovascular morbidity and mortality are extremely high in all stages of renal failure. Arterial hypertension remains a major problem even after renal transplantation. We studied retrospectively the hypertension patterns in recipients of renal allografts from living donors from January 1998 to December 2004. The mean age of the patients was 29.3 +/- 9.4 (range 13 - 54) years, with a male predominance (62%). Among 42 of the study patients, 40 (95%) were hypertensive at 3 months after transplantation with a slightly decreasing prevalence at 6 and 12 months to 84% and 85%, respectively. During dialysis period, 59.5% of the patients were hypertensive. The allografts were left kidneys with only one artery in 40 patients and right kidneys with 2 arteries in 2 patients. Graft renal artery stenosis (RAS) was documented by Doppler ultrasound in 13 (32.5%) cases. Three patients improved following transluminal angioplasty with stenting. The control of the hypertension required the use of at least two anti-hypertensive drugs in 56% of patients. On an average follow-up of 30 (1 - 78) months, no cardio-vascular event was reported and all the allografts remained functional. We conclude that hypertension is prevalent in the living renal allografts recipients. The etiology is multifactorial and careful management is mandatory to protect the renal function and the cardiovascular system.