Management of the kidney transplant recipient in the intensive care unit

A case of bilateral cortical blindness followed by generalised tonic-clonic seizure epilepsy in a patient with posterior reversible encephalopathy syndrome

Posterior reversible encephalopathy syndrome (PRES) in end-stage kidney disease (ESKD) is rare, with ocular symptoms as the first manifestation being even rarer. Here, we report a case of PRES in a patient with ESKD, characterized by sudden binocular blurred vision followed by epilepsy, to improve the understanding of this syndrome among nephrologists and ophthalmologists. A 50-year-old female requested an ophthalmic consultation due to bilateral vision loss followed by generalised tonic-clonic seizures. One month before onset of current illness, she developed ESKD secondary to rapid progression of previous ANCA vasculitis associated renal damage. Latter magnetic resonance imaging confirmed the diagnosis of PRES. Two weeks later, the patient's vision fully recovered. Conclusion: PRES is not an etiological diagnosis but a neuroimaging sign. In addition, PRES is a danger signal that is usually reversible if recognized and treated early, and can be life-threatening if treatment is delayed.

Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation - update of recent literature

PURPOSE OF REVIEW

This review aims to present the recent literature regarding effects of aging and ureteral stent implantation (UrS) on the risk of urinary tract infections (UTIs) in kidney transplant (KTX) recipients.

RECENT FINDINGS

UTIs in kidney transplant recipients remain a clinical challenge and represent a leading cause of morbidity, hospitalization rates, and mortality. Higher age was described as a significant risk factor for UTIs in several studies including a recent Brazilian analysis, indicating a 3.6%/years of age increase in UTI risk. Subsequently, a large meta-analysis, published in 2023, confirmed the correlation between older age and elevated UTI risk. The Swiss Transplant Cohort Study in 2022, largest of its kind, similarly confirmed a link between advanced age and heightened risk of recurrent UTIs in KTX. A recent prospective study highlighted UrS placement as a modifiable risk factor, emphasizing the need for careful consideration and antibiotic prophylaxis. Additionally, the type of stents played a crucial role, with external stents associated with a 1.69 times higher UTI risk. The challenge of determining optimal UrS removal timing further complicates posttransplant care, with insufficient evidence to guide practices.

SUMMARY

The aging population of KTX recipients requires a personalized approach to effectively reduce and manage UTIs as one of the most important complications following KTX. Prophylactic stent implantation is successful in lowering ureteral complications, however, is associated with an increased incidence of UTIs. To reduce the increased risk of UTIs, the length of stent insertion requires strict supervision and maintenance.