Causes of frequency and nocturia after renal transplantation.

OBJECTIVE: To explore the role of bladder capacity, bladder pain, dysfunctional voiding, urgency, urinary tract infections (UTIs), and urinary output as potential causes of frequency and nocturia after renal transplantation. PATIENTS AND METHODS: Data were gathered from 52 adult renal transplant patients (35 men and 17 women, mean age 49 years), using a written questionnaire, medical records, frequency/volume charts, and urinary cultures. The mean time between transplantation and data collection was 5 months. Structural equation modelling (SEM) was used for the simultaneous assessment of direct and indirect relationships between explanatory variables and voiding frequency. RESULTS: Frequency and nocturia were found in 54% and 60% of the study population, respectively. Frequency was directly associated with a small bladder capacity, bladder pain, urgency, and a high daytime urine volume, and indirectly by UTIs (via urgency and bladder pain). Nocturia was associated with high nocturnal urine volume, small bladder capacity and dysfunctional voiding. A quarter of the patients had small bladders and another quarter had large bladders, the latter being associated with nocturnal polyuria. CONCLUSIONS: The presence of frequency, especially when accompanied by bladder pain, might aid the physician to identify patients with small bladders. The presence of nocturia can be the result of a high nocturnal urine volume, which increases the risk of bladder enlargement. Because both abnormal bladder conditions can contribute to graft dysfunction, we recommend a urological follow-up after renal transplantation, using frequency/volume charts.

Lower urinary tract symptoms after renal transplantation: are there changes over time?

OBJECTIVES: To examine the changes in bladder function after renal transplantation by comparing lower urinary tract symptoms in the first and third years after transplantation in a group of renal transplant recipients. METHODS: The long-term changes in bladder function after transplantation were studied using a longitudinal study design. The study group consisted of 53 patients who underwent renal transplantation in 1998 at the University Medical Centre Nijmegen and who returned a completed questionnaire about their micturition pattern in the first and third year after transplantation. The data on symptoms of lower urinary tract dysfunction were collected using the International Continence Society (male) and Bristol Female Lower Urinary Tract Symptoms questionnaires. The control group consisted of 74 patients who visited the Outpatient Clinic of Otorhinolaryngology at year 1. In our analyses, we compared the micturition behavior of the transplant group at year 3 with the control group and with their own micturition behavior at year 1. RESULTS: The results of our study showed that 3 to 4 years after transplantation, the renal transplant group still urinated significantly more often during the day and during the night than did the control patients. Furthermore, among most (63% to 68%) of the patients who showed these symptoms in the first year after transplantation, the symptoms were still present 2 to 3 years later. CONCLUSIONS: The frequency and incidence of nocturia among renal transplant patients are fairly persistent phenomena.

A controlled trial comparing two doses of cyclosporine in conjunction with mycophenolate mofetil and corticosteroids.

It is unknown whether the addition of mycophenolate mofetil (MMF) to cyclosporine (CsA) and prednisone after renal transplantation (RTx) allows for a reduced dose of CsA, to minimize the incidence of CsA-related side effects and to reduce costs. Therefore, 313 renal allograft recipients were randomized for treatment with MMF (1000 mg twice a day), prednisone, and either conventional- or low-dose CsA during the first 3 mo after RTx. The target trough levels were 300 and 150 ng/ml, respectively, during the first 3 mo and 150 ng/ml in both groups thereafter. A total of 313 patients were included: 161 patients received a conventional dose and 152 received a low dose of CsA. During the first 6 mo after RTx, graft failure or patient death occurred in 19 of 161 patients (12%) in the conventional-dose group and in 11 of 152 patients (7%) in the low-dose group (not significant). Biopsy-proven acute rejection occurred in 36 of 161 patients (22%) in the conventional-dose group and in 29 of 152 patients (19%) in the low-dose group (not significant). The incidence of delayed graft function was similar in both groups (31 of 161 [19%] versus 28 of 152 [18%]; not significant). Serum creatinine did not differ between the conventional- and the low-dose groups: 151 +/- 56 micromol/L versus 142 +/- 49 micromol/L at 3 mo and 141 +/- 60 micromol/L versus 136 +/- 49 micromol/L at 6 mo. There were no differences between the groups regarding BP, lipid metabolism, and infectious complications. In the low-dose group, an estimated $500 per patient was saved on the costs of CsA. In conclusion, the addition of MMF to CsA and prednisone after RTx allows the use of a lower-than-conventional dose of CsA, without increasing the risk of rejection.