Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Individuals with end-stage kidney disease (ESKD), and especially those who have received kidney transplants, are at an increased risk of developing urinary tract infection (UTI). UTI, especially recurrent UTI, is a common problem occurring in >75% of kidney transplant (KTX) recipients. Progression of infection can have significant consequences on the functioning of the transplanted kidney. It may be challenging to distinguish complicated UTI from acute or chronic rejection when patients present with fever and abdominal pain at the transplanted location. In this case study, we present the clinical scenario of a patient with a history of hypertension and ESKD who has one functioning transplanted kidney and went on to develop a UTI that progressed to pyelonephritis.
Case presentation: A female patient, 55 years old, with a medical history including appendectomy, hypertension (HTN), recurrent urinary tract infections (UTI), and end-stage kidney disease (ESKD) following a kidney transplant in 2017, is currently taking post-transplant anti-rejection medications, namely Tacrolimus and Mycophenolate. She visited the emergency department seeking evaluation for pain in the lower right abdomen that radiates to the back. She also reported intermittent fevers, chills, and increased urinary frequency. During the physical examination, tenderness was noted in the lower right quadrant. Laboratory tests revealed leukocytosis, a slightly elevated Creatinine level of 1.8 mg/dl, and the presence of numerous bacteria in the urine. A CT scan of the abdomen showed atrophic native kidneys and a transplanted kidney in the lower right quadrant without hydronephrosis.
In the previous month, the patient had been diagnosed with a complicated UTI caused by pan-sensitive Escherichia coli (E. Coli). She received three days of intravenous Cefepime and was discharged with Cephalexin. Since her kidney transplant six years ago, she has been consistently taking Tacrolimus and Mycophenolate to prevent rejection of the transplanted organ. Her blood pressure has been well controlled, and chronic allograft rejection is considered less likely as the cause of her symptoms. Considering her history of recurrent UTIs and previous use of a fourth-generation cephalosporin, Zosyn (Piperacillin-Tazobactam) is a suitable choice of antibiotic for the current infection. This is particularly relevant as the urine culture results showed that the E. Coli strain is resistant to multiple drugs but susceptible to Zosyn. The patient responded positively to the antibiotic therapy and was discharged with plans for ambulatory infusion follow-up using intravenous Zosyn at home.
Conclusion: Escherichia coli (E. coli) continues to be a prevalent pathogen responsible for urinary tract infections (UTIs), both in individuals without underlying health conditions and in patients who have undergone kidney transplantation. When dealing with suspected complicated UTIs, it is crucial to rule out the possibility of acute or chronic renal allograft rejection. In addition, it is important to gather information about the patient's healthcare settings, such as nursing homes, as this can aid in guiding antibiotic therapy. Utilizing broad-spectrum antimicrobials may be necessary while awaiting the results of urine culture and sensitivity testing to ensure appropriate treatment.
Academic/Professional Position
Medical Student
Academic/Professional Position (Other)
MS3
Recommended Citation
Jhaveri, Shuchita; Bouls, Ruayda; Ngo, Duc Khiem; and Garcia, Laura E., "Case Report: Kidney Transplant Pyelonephritis" (2024). Research Symposium. 42.
https://scholarworks.utrgv.edu/somrs/2023/posters/42
Included in
Case Report: Kidney Transplant Pyelonephritis
Background: Individuals with end-stage kidney disease (ESKD), and especially those who have received kidney transplants, are at an increased risk of developing urinary tract infection (UTI). UTI, especially recurrent UTI, is a common problem occurring in >75% of kidney transplant (KTX) recipients. Progression of infection can have significant consequences on the functioning of the transplanted kidney. It may be challenging to distinguish complicated UTI from acute or chronic rejection when patients present with fever and abdominal pain at the transplanted location. In this case study, we present the clinical scenario of a patient with a history of hypertension and ESKD who has one functioning transplanted kidney and went on to develop a UTI that progressed to pyelonephritis.
Case presentation: A female patient, 55 years old, with a medical history including appendectomy, hypertension (HTN), recurrent urinary tract infections (UTI), and end-stage kidney disease (ESKD) following a kidney transplant in 2017, is currently taking post-transplant anti-rejection medications, namely Tacrolimus and Mycophenolate. She visited the emergency department seeking evaluation for pain in the lower right abdomen that radiates to the back. She also reported intermittent fevers, chills, and increased urinary frequency. During the physical examination, tenderness was noted in the lower right quadrant. Laboratory tests revealed leukocytosis, a slightly elevated Creatinine level of 1.8 mg/dl, and the presence of numerous bacteria in the urine. A CT scan of the abdomen showed atrophic native kidneys and a transplanted kidney in the lower right quadrant without hydronephrosis.
In the previous month, the patient had been diagnosed with a complicated UTI caused by pan-sensitive Escherichia coli (E. Coli). She received three days of intravenous Cefepime and was discharged with Cephalexin. Since her kidney transplant six years ago, she has been consistently taking Tacrolimus and Mycophenolate to prevent rejection of the transplanted organ. Her blood pressure has been well controlled, and chronic allograft rejection is considered less likely as the cause of her symptoms. Considering her history of recurrent UTIs and previous use of a fourth-generation cephalosporin, Zosyn (Piperacillin-Tazobactam) is a suitable choice of antibiotic for the current infection. This is particularly relevant as the urine culture results showed that the E. Coli strain is resistant to multiple drugs but susceptible to Zosyn. The patient responded positively to the antibiotic therapy and was discharged with plans for ambulatory infusion follow-up using intravenous Zosyn at home.
Conclusion: Escherichia coli (E. coli) continues to be a prevalent pathogen responsible for urinary tract infections (UTIs), both in individuals without underlying health conditions and in patients who have undergone kidney transplantation. When dealing with suspected complicated UTIs, it is crucial to rule out the possibility of acute or chronic renal allograft rejection. In addition, it is important to gather information about the patient's healthcare settings, such as nursing homes, as this can aid in guiding antibiotic therapy. Utilizing broad-spectrum antimicrobials may be necessary while awaiting the results of urine culture and sensitivity testing to ensure appropriate treatment.