Influence of Pre-renal Transplant Secondary Hyperparathyroidism on Later Evolution After Transplantation.

Persistence of secondary hyperparathyroidism (SHPT) is common after renal transplantation. Good diagnosis and treatment are important to avoid complications. The objective of our work was to perform a retrospective analysis of the evolution of SHPT after renal transplantation. We selected patients who had received a kidney transplant at our hospital between 2000 and 2014. The biochemical variables of chronic kidney disease-metabolic bone disorders (CKD-MBD) were collected at pretransplantation and at 3, 6, 12, and 24 months post-transplantation. Treatments related to SHPT were also analyzed. Five hundred forty-three renal transplants were included. The average preoperative parathyroid hormone (PTH) was 241.14 pg/mL, 115.7 pg/mL at 3 months, and at 12 and 24 months postoperatively, PTH levels stabilized to 112 pg/mL. Treatment related to SHPT was present in 27.3% of patients during the preoperative period, 40.4% at 3 months postoperatively, 24.2% at 12 months postoperatively, and 23.2% at 24 months postoperatively. There was a significant association between requiring some type of treatment preoperatively and the rest of the postoperative periods (P < .005). The sample was later divided into 3 groups based on preoperative PTH (1: <150 pg/mL, n = 223 [41.1%]; 2: 150-300 pg/mL, n = 173 [31.9%]; 3: >300 pg/mL, n = 147 [27.1%]) and their evolutions were compared. Higher levels of postoperative PTH in group pre-PTH 3 were observed. Group 3 also presented with greater need for treatment in the postoperative periods, with significant association (P < .05). A regression analysis was performed and found that postoperative PTH were dependent on preoperative PTH adjusted by glomerular filtration. In conclusion, parameters related to CKD-MBD (mainly PTH) after kidney transplant, dependent on preoperative levels and glomerular filtration. Patients with a greater grade of SHPT presented with higher levels of postoperative PTH despite receiving more intensive treatment.

Short-Term Outcome of Untreated Versus Treated Asymptomatic Bacteriuria in Renal Transplant Patients.

BACKGROUND: Infection of the urinary tract (UTI) is the most common form of bacterial infection in renal transplant patients, but its management is still controversial. We compared symptomatic and asymptomatic bacteriuria, treated or untreated, during two different months (summer or winter). METHODS: This longitudinal, prospective study involved routine urine cultures collected during September 2014 or March 2015. Demographic, clinical, and microbiological characteristics from the patients with positive urine cultures were described. The main outcomes were the need of hospitalization, the bacterial clearance, and the selection of the resistant pathogen. RESULTS: From the 538 urine cultures collected, only 61 were positive urine cultures. Twenty were untreated asymptomatic bacteriuria (AB), 28 were treated AB, and 13 were treated symptomatic bacteriuria. The more prevalent micro-organisms were E coli (27%), K pneumoniae (11%), and E faecalis (7%). There were no differences in the demographic, clinical, and microbiological characteristics depending on the month when the urine cultures were collected. Only 10 patients required hospitalization during follow-up, and all of them belonged to the treated group. Bacterial clearance after the treatment occurred in 20 patients of the 41 treated (48.9%) and spontaneously in 14 of the 20 patients untreated (70%). Of the treated patients, 47.6% developed a new resistance to another antibiotic. CONCLUSIONS: Only 7.6% of the routine urine cultures on renal transplant were positive. Untreated AB did not require hospitalization, and 70% had spontaneous bacterial clearance.