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Dang J, Scemla A, Loheac C, Chaba A, Bienaimé F, Joly D, Legendre C, Knebelmann B, Charlier C. Efficacy of Prolonged Antibiotic Therapy for Renal Cyst Infections in Polycystic Kidney Disease. Mayo Clin Proc 2022; 97:1305-1317. [PMID: 35787857 DOI: 10.1016/j.mayocp.2022.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/05/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the impact of antibiotic therapy (ATBT) on outcomes of renal cyst infection (CyI) in patients with polycystic kidney disease. PATIENTS AND METHODS We undertook a single-center retrospective study of CyI in autosomal dominant polycystic kidney disease (January 1, 2000, through December 31, 2018). Cyst infections were classified as definite (microbiologically proven), probable (radiologic signs), or possible (clinical or biologic signs only). We studied the determinants of ATBT failure (persistence of infection beyond 72 hours of microbiologically adequate initial ATBT, with requirement for ATBT change, cyst drainage, or nephrectomy) and recurrences (>14 days after the end of ATBT). RESULTS Among 90 patients, 139 CyIs (11 definite, 74 probable, 54 possible) were compiled. Cultures were positive in 106 of 139 (76%) episodes, with Escherichia coli found in 89 of 106 (84%). Treatment failures and recurrences within 1 year of follow-up were more frequent in definite/probable CyI (20/85 [34%] and 16/85 [19%]) than in possible CyI (2/54 [4%] and 4/54 [7%]; P<.01 and P=.08, respectively). Male sex (odds ratio [OR], 7.79; 95% CI, 1.72 to 46.68; P<.01), peak C-reactive protein level above 250 mg/L (OR, 7.29; 95% CI, 1.78 to 35.74; P<.01; to convert C-reactive protein values to nmol/L, multiply by 9.524), and cyst wall thickening (OR, 7.70; 95% CI, 1.77 to 43.47; P=.01) but not the modalities of initial ATBT were independently associated with higher risk of failure. In a Cox proportional hazards model, kidney transplant recipients exhibited higher risk of recurrence (hazard ratio, 3.76; 95% CI, 1.06 to 13.37; P=.04), whereas a total duration of ATBT of 28 days or longer was protective (hazard ratio, 0.02; 95% CI, 0.00 to 0.16; P<.001), with an inverse correlation between duration and recurrence (81% for treatment <21 days, 47% for 21 to 27 days, 2% for ≥28 days; P<.0001). CONCLUSION Initial first-line ATBT had no significant effect on renal CyI treatment failure. Treatment duration of 28 days and longer reduced recurrences.
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Affiliation(s)
- Julien Dang
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Anne Scemla
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Charlotte Loheac
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Anis Chaba
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Frank Bienaimé
- Service de Physiologie, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Dominique Joly
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Christophe Legendre
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Bertrand Knebelmann
- Université de Paris, Service de Néphrologie et Transplantation, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, France
| | - Caroline Charlier
- Université de Paris, Equipe Mobile Infectiologie, Hôpital Paris Centre, Assistance Publique-Hôpitaux de Paris, France.
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Suwabe T. Cyst infection in autosomal dominant polycystic kidney disease: our experience at Toranomon Hospital and future issues. Clin Exp Nephrol 2020; 24:748-761. [PMID: 32700112 PMCID: PMC7474715 DOI: 10.1007/s10157-020-01928-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 07/06/2020] [Indexed: 12/22/2022]
Abstract
Cyst infection is a frequent and serious complication of autosomal dominant polycystic kidney disease (ADPKD) that is often difficult to treat and can be fatal. However, much is still unknown about cyst infection. Positron emission tomography (PET) is generally recommended for detecting infected cysts, but it has the disadvantages of limited availability, high cost, and radiation exposure. We have devised magnetic resonance imaging (MRI) diagnostic criteria for cyst infection. Lipid-soluble antibiotics such as fluoroquinolones show good penetration into cysts and are recommended for cyst infection. However, we reported that fluoroquinolone-resistant microorganisms showed a high prevalence in cyst infection. We should, therefore, reconsider the empirical use of fluoroquinolones for ADPKD patients with cyst infection. We have suggested a new antibiotic strategy according to the severity of cyst infection. It may be important to consider the drug half-life in serum in addition to the drug susceptibility when selecting antibiotics Cyst drainage is necessary for some patients with refractory cyst infection; however, cyst drainage can be associated with severe adverse events. We suggest adaptation criteria for cyst drainage in patients with cyst infection in ADPKD. Most causative bacteria of cyst infection are enterobacteria, and hematogenous spread via bacterial translocation in the intestine is considered the main cause of cyst infection. Therefore, intestinal flora may be important for cyst infection. The role of the intestinal flora in cyst infection in ADPKD is unknown and should be explored in future research.
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Affiliation(s)
- Tatsuya Suwabe
- Department of Nephrology, Toranomon Hospital Kajigaya, 1-3-1 Kajigaya, Takatsu-ku, Kawasaki-shi, Kanagawa-ken, 213-0015, Japan.
- Okinaka Memorial Institute for Medical Research, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan.
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Charlier C, Dang J, Woerther PL. In-hospital management of acute complicated urinary tract infections. Nephrol Ther 2019; 15 Suppl 1:S27-S32. [PMID: 30981392 DOI: 10.1016/j.nephro.2019.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/11/2019] [Indexed: 10/27/2022]
Abstract
Upper tract urinary tract infections that require hospitalization have been the focus of national recommendations in 2018 by the French society of infectious diseases (Spilf). We here propose to discuss several complex-challenging situations: severe infection with sepsis, pyelonephritis in the pregnant woman, management of infections involving multiresistant bacteria and infection in polycystic kidney disease.
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Affiliation(s)
- Caroline Charlier
- Université de Paris, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France; Service de maladies infectieuses et tropicales, centre hospitalier universitaire Necker-Enfants-Malades, Assistance publique-Hôpitaux de Paris, 149, rue de Sèvres, 75015 Paris, France; Institut Imagine, 24, boulevard de Montparnasse, 75015 Paris, France; Centre national de référence, centre collaborateur OMS Listeria, Institut Pasteur, 25-28, rue du Docteur- Roux, 75724 Paris, France; Inserm U1117, unité de biologie des infections, 28, rue du Docteur-Roux, 75724 Paris cedex 15, France.
| | - Julien Dang
- Institut Imagine, 24, boulevard de Montparnasse, 75015 Paris, France; Service de néphrologie, centre hospitalier universitaire Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France
| | - Paul-Louis Woerther
- Unité de bactériologie, groupe hospitalier Henri-Mondor, 51, avenue du Maréchal-de-Lattre-de-Tassigny, 94010 Créteil cedex, France; Université Paris-Est-Créteil-Val-de-Marne, avenue du Général-de-Gaulle, 94010 Créteil cedex, France
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4
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Eroglu E, Kocyigit I, Cetin M, Zararsiz G, Imamoglu H, Bayramov R, Tastan S, Sipahioglu MH, Tokgoz B, Oymak O. Multiple urinary tract infections are associated with genotype and phenotype in adult polycystic kidney disease. Clin Exp Nephrol 2019; 23:1188-1195. [PMID: 31165946 DOI: 10.1007/s10157-019-01752-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/24/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Urinary tract infections (UTI) are one of the important clinical presentations in patients with autosomal dominant polycystic kidney disease (ADPKD). The association between UTI among genotypic and phonotypic properties of ADPKD patients is still obscure. Thus, we investigated the relationship between UTI and polycystin gene mutation with total kidney volume. METHODS Forty patients with ADPKD patients with a history of more than two UTI and age-gender-matched 40 ADPKD patients without UTI history enrolled in the study. Ambulatory blood pressure monitoring was performed in all participants. Magnetic resonance imaging (MRI) was performed with a 1.5-T system, and total kidney volumes were calculated using mid-slice technique. To determine PKD1 and PKD2 genotype, we performed molecular and genetic tests involving the following steps: DNA isolation, next-generation sequencing (NGS) and data analysis. RESULTS ADPKD patients with UTI had lower eGFR values than those without UTI [64.9 (32.2-100.8) vs 89.5 (59.0-110.0) (p = 0.041)]. In addition, patients with UTI had significantly increased height-adjusted total kidney volume than patients without UTI [950 (290-1350) vs 345 (243-780.0) (p = 0.005)]. Multiple logistic regression analysis showed that the PKD1-truncating mutation and hTKV independently predicted UTI. The sensitivity and specificity of hTKV were 65% and 77% (cutoff > 727 cm3) with an area of under the ROC curve of 0.70 (95% CI 0.56-0.85, p = 005). CONCLUSIONS ADPKD patients with larger kidneys and PKD1 mutation are susceptible to increased risk of multiple UTI. Additionally, renal function decreased in ADPKD patients with multiple UTI history.
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Affiliation(s)
- Eray Eroglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey.
| | - Ismail Kocyigit
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Mustafa Cetin
- Department of Internal Medicine, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Gokmen Zararsiz
- Department of Biostatistics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Hakan Imamoglu
- Department of Radiology, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Ruslan Bayramov
- Department of Genetics, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Sinem Tastan
- Department of Infectious Disease, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Murat Hayri Sipahioglu
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Bulent Tokgoz
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
| | - Oktay Oymak
- Division of Nephrology, Department of Internal Medicine, Erciyes University Medical Faculty, 38039, Kayseri, Turkey
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Neuville M, Hustinx R, Jacques J, Krzesinski JM, Jouret F. Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease. PLoS One 2016; 11:e0161277. [PMID: 27529555 PMCID: PMC4987061 DOI: 10.1371/journal.pone.0161277] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/02/2016] [Indexed: 12/15/2022] Open
Abstract
Background Acute febrile abdomen represents a diagnostic challenge in patients with autosomal dominant polycystic kidney disease (ADPKD). Although criteria have been proposed for cyst infection (CyI) and hemorrhage (CyH), there is a lack of comparative assessments. Furthermore, distinguishing cystic from non-cystic complications remains problematic. Design ADPKD patients presenting with abdominal pain and/or fever between 01/2005 and 06/2015 were retrospectively identified in a systematic computerized billing database. CyH was defined as spontaneous intracystic density above 50 Hounsfield units on computed tomography (CT). CyI was definite if confirmed by cyst puncture, and probable if 4 criteria were met: 3-day fever, loin/liver tenderness, C-reactive protein (CRP) plasma levels >50mg/L and no CT evidence for CyH. Other episodes were grouped as inflammation of unknown origin (IUO). Results Among a cohort of 173 ADPKD patients, 101 presented with 205 episodes of abdominal pain (n = 172) and/or fever (n = 33). 20 patients experienced 30 CyH, whereas 16 presented 23 episodes of definite (n = 11) or probable (n = 12) CyI. 35 IUO were observed in 31 patients. Clinically, fever was observed in 7% vs. 100% vs. 66% of CyH, CyI and IUO, respectively. Biologically, CRP cut-off at 70 mg/dl showed 92% sensitivity and 81% specificity in CyI diagnosis. Urine or blood cultures remained sterile in >90% of CyH, but were contributive in 53.4% of CyI and IUO, with a 74.2% prevalence for E. coli. Radiologically, ultrasounds, CT and magnetic resonance diagnosed CyI in 2.6%, 20% and 16.7% of cases, respectively. 18F-FDG positron-emission tomography (PET)/CT was done within a median period of 7 days post antibiotics, and significantly changed patient management in 71.4%. Conclusions This retrospective single-center series underscores the usefulness of clinical–fever–and biological–CRP–parameters, but emphasizes the limitations of bacteriological and radiological investigations in cases of acute febrile abdomen in ADPKD patients. 18F-FDG-PET/CT imaging may be helpful in such condition.
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Affiliation(s)
- Marie Neuville
- Department of Nephrology, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - Roland Hustinx
- Department of Nuclear Medicine, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - Jessica Jacques
- Department of Medico-Economic Information, University of Liège Hospital (ULg CHU), Liège, Belgium
| | - Jean-Marie Krzesinski
- Department of Nephrology, University of Liège Hospital (ULg CHU), Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium
| | - François Jouret
- Department of Nephrology, University of Liège Hospital (ULg CHU), Liège, Belgium
- Groupe Interdisciplinaire de Génoprotéomique Appliquée (GIGA), Cardiovascular Sciences, University of Liège, Liège, Belgium
- * E-mail:
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6
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Ito K, Yamamoto T, Nishio H, Sawaya A, Murakami M, Kitagawa A, Matsuo Y, Matsuo K, Tanaka S, Mori N. Bacteremic kidney cyst infection caused by Helicobacter cinaedi. CEN Case Rep 2015; 5:121-124. [PMID: 28508961 DOI: 10.1007/s13730-015-0207-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 11/20/2015] [Indexed: 11/30/2022] Open
Abstract
Cyst infection is one of the major complications in patients with autosomal dominant polycystic kidney disease (ADPKD). The causative pathogen in kidney cyst infection frequently goes undetected. Although only one case report of kidney cyst infection caused by Helicobacter cinaedi (H. cinaedi) is published in English literature, it may be an important pathogen in kidney cyst infection. Kidney cyst infection and H. cinaedi infection share the common characteristic of tendency to relapse and chronic kidney disease is a major risk factor for H. cinaedi infection. Moreover, a long period is required to detect H. cinaedi in blood cultures, potentially causing false-negative results. After the identification of H. cinaedi, we must carefully select antibiotics and the antibiotic treatment period should be extended to prevent recurrence. Here we present a case of a 58-year-old male with ADPKD who developed bacteremic kidney cyst infection caused by H. cinaedi. He was admitted to our hospital because of fever, lower left back pain, vomiting, and feeling of abdominal enlargement. H. cinaedi was detected from the blood cultures obtained at admission after 4 days of culture. Antibiotics were administered for 8 weeks after confirming negative blood cultures. There was no evidence of kidney cyst infection relapse at 3 months after treatment completion. Nephrologists should regard H. cinaedi as a challenging but important pathogen in kidney cyst infection, particularly when the causative organism is unknown or kidney cyst infection is recurrent.
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Affiliation(s)
- Kenta Ito
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan.
| | - Takumi Yamamoto
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Haruomi Nishio
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Asako Sawaya
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Masaaki Murakami
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Akiko Kitagawa
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Yoko Matsuo
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Ken Matsuo
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Satoshi Tanaka
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
| | - Noriko Mori
- Department of Nephrology, Shizuoka General Hospital, 4-27-1 Kitaando, Aoi-ku, Shizuoka, 420-8527, Japan
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Bobot M, Ghez C, Gondouin B, Sallée M, Fournier PE, Burtey S, Legris T, Dussol B, Berland Y, Souteyrand P, Tessonnier L, Cammilleri S, Jourde-Chiche N. Diagnostic performance of [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography in cyst infection in patients with autosomal dominant polycystic kidney disease. Clin Microbiol Infect 2015; 22:71-77. [PMID: 26454062 DOI: 10.1016/j.cmi.2015.09.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/23/2015] [Accepted: 09/24/2015] [Indexed: 11/18/2022]
Abstract
Cyst infection is a common complication of autosomal dominant polycystic kidney disease (ADPKD). Diagnosis is challenging with standard imaging techniques. We aimed to evaluate the diagnostic performance of [(18)F]fluorodeoxyglucose positron emission tomography-computed tomography (18-FDG PET-CT) for the diagnosis of cyst infections among ADPKD patients, in comparison with computed tomography (CT) and magnetic resonance imaging (MRI). All APKD patients who underwent 18-FDG PET-CT for suspected cyst infection between 2006 and 2013 in a French teaching hospital were included. Diagnosis of cyst infection was retained a posteriori on an index of clinical suspicion. 18-FDG PET-CT findings were was considered to be positive in cases of cyst wall hypermetabolism. CT or MRI findings were were considered to be positive in cases of cyst wall thickening (and enhancement if contrast medium was injected) and infiltration of the adjacent fat. A control group of ADPKD patients with 18-FDG PET-CT performed for other reasons was included. Thirty-two 18-FDG PET-CT scans were performed in 24 ADPKD patients with suspected cyst infection. A diagnosis of cyst infection was retained in 18 of 32 cases: 14 with positive 18-FDG PET-CT findings, and four false negatives. There were no false positives and no hypermetabolism of cyst walls in nine ADPKD control patients. 18-FDG PET-CT had a sensitivity of 77%, a specificity of 100%, and a negative predictive value of 77%. 18-FDG PET-CT allowed a differential diagnosis in three patients. In contrast, CT had a sensitivity of 7% and a negative predictive value of 35% (p <0.001 vs. 18-FDG PET-CT). Only eight MRI scans were performed. The diagnostic performance of 18-FDG PET-CT is superior to that of CT in cyst infections, for comparable radiation doses and with no injection of nephrotoxic contrast medium, in ADPKD patients.
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Affiliation(s)
- M Bobot
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - C Ghez
- Aix-Marseille University, Department of Radiology, AP-HM Hopital Conception, Marseille, France
| | - B Gondouin
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - M Sallée
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - P E Fournier
- Aix-Marseille University, Department of Infectious Diseases, Unité de Recherche sur les Maladies Infectieuses et Tropicales Emergentes, AP-HM Hopital Timone, Marseille, France
| | - S Burtey
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - T Legris
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - B Dussol
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - Y Berland
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France
| | - P Souteyrand
- Aix-Marseille University, Department of Radiology, AP-HM Hopital Conception, Marseille, France
| | - L Tessonnier
- Aix-Marseille University, Department of Radiology, AP-HM Hopital Conception, Marseille, France
| | - S Cammilleri
- Aix-Marseille University, Department of Nuclear Medicine, AP-HM Hopital Timone, Marseille, France
| | - N Jourde-Chiche
- Aix-Marseille University, Department of Nephrology, AP-HM Hopital Conception, Marseille, France.
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8
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Vidal E, Cervera C, Cordero E, Armiñanzas C, Carratalá J, Cisneros JM, Fariñas MC, López-Medrano F, Moreno A, Muñoz P, Origüen J, Sabé N, Valerio M, Torre-Cisneros J. Management of urinary tract infection in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2015; 33:679.e1-679.e21. [PMID: 25976754 DOI: 10.1016/j.eimc.2015.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common infections in solid organ transplant (SOT) recipients. METHODS Experienced SOT researchers and clinicians have developed and implemented this consensus document in support of the optimal management of these patients. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic-therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included. CONCLUSIONS The latest scientific information on UTI in SOT is incorporated in this consensus document.
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Affiliation(s)
- Elisa Vidal
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Instituto Maimónides de Investigación en Biomedicina de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
| | - Carlos Cervera
- Servicio de Enfermedades Infecciosas, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Carlos Armiñanzas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Jordi Carratalá
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - José Miguel Cisneros
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - M Carmen Fariñas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Asunción Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julia Origüen
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Núria Sabé
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - Maricela Valerio
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julián Torre-Cisneros
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Instituto Maimónides de Investigación en Biomedicina de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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9
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Suwabe T, Araoka H, Ubara Y, Kikuchi K, Hazue R, Mise K, Hamanoue S, Ueno T, Sumida K, Hayami N, Hoshino J, Imafuku A, Kawada M, Hiramatsu R, Hasegawa E, Sawa N, Takaichi K. Cyst infection in autosomal dominant polycystic kidney disease: causative microorganisms and susceptibility to lipid-soluble antibiotics. Eur J Clin Microbiol Infect Dis 2015; 34:1369-79. [DOI: 10.1007/s10096-015-2361-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 03/06/2015] [Indexed: 11/30/2022]
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10
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Cervera C, van Delden C, Gavaldà J, Welte T, Akova M, Carratalà J. Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect 2014; 20 Suppl 7:49-73. [DOI: 10.1111/1469-0691.12687] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 12/23/2022]
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11
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Balbo BEP, Sapienza MT, Ono CR, Jayanthi SK, Dettoni JB, Castro I, Onuchic LF. Cyst infection in hospital-admitted autosomal dominant polycystic kidney disease patients is predominantly multifocal and associated with kidney and liver volume. ACTA ACUST UNITED AC 2014; 47:584-93. [PMID: 24919173 PMCID: PMC4123838 DOI: 10.1590/1414-431x20143584] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 03/17/2014] [Indexed: 12/17/2022]
Abstract
Positron-emission tomography/computed tomography (PET/CT) has improved cyst infection
(CI) management in autosomal dominant polycystic kidney disease (ADPKD). The
determinants of kidney and/or liver involvement, however, remain uncertain. In this
study, we evaluated clinical and imaging factors associated with CI in kidney (KCI)
and liver (LCI) in ADPKD. A retrospective cohort study was performed in
hospital-admitted ADPKD patients with suspected CI. Clinical, imaging and surgical
data were analyzed. Features of infected cysts were evaluated by PET/CT. Total kidney
(TKV) and liver (TLV) volumes were measured by CT-derived multiplanar reconstruction.
CI was detected in 18 patients who experienced 24 episodes during an interval of 30
months (LCI in 12, KCI in 10 and concomitant infection in 2). Sensitivities of CT,
magnetic resonance imaging and PET/CT were 25.0, 71.4, and 95.0%. Dysuria
(P<0.05), positive urine culture (P<0.01), and previous hematuria (P<0.05)
were associated with KCI. Weight loss (P<0.01) and increased C-reactive protein
levels (P<0.05) were associated with LCI. PET/CT revealed that three or more
infected cysts were present in 70% of the episodes. TKV was higher in kidney-affected
than in LCI patients (AUC=0.91, P<0.05), with a cut-off of 2502 mL (72.7%
sensitivity, 100.0% specificity). TLV was higher in liver-affected than in KCI
patients (AUC=0.89, P<0.01) with a cut-off of 2815 mL (80.0% sensitivity, 87.5%
specificity). A greater need for invasive procedures was observed in LCI (P<0.01),
and the overall mortality was 20.8%. This study supports PET/CT as the most sensitive
imaging method for diagnosis of cyst infection, confirms the multifocal nature of
most hospital-admitted episodes, and reveals an association of kidney and liver
volumes with this complication.
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Affiliation(s)
- B E P Balbo
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M T Sapienza
- Divisão de Medicina Nuclear, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - C R Ono
- Divisão de Medicina Nuclear, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - S K Jayanthi
- Divisão de Radiologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J B Dettoni
- Divisão de Patologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - I Castro
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - L F Onuchic
- Divisão de Nefrologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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12
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Interventions for infected cysts in people with autosomal dominant polycystic kidney disease. Hippokratia 2014. [DOI: 10.1002/14651858.cd010946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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13
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Kim H, Cho Park H, Lee S, Lee J, Cho C, Kim DK, Hwang YH, Oh KH, Ahn C. Successfully treated Escherichia coli-induced emphysematous cyst infection with combination of intravenous antibiotics and intracystic antibiotics irrigation in a patient with autosomal dominant polycystic kidney disease. J Korean Med Sci 2013; 28:955-8. [PMID: 23772165 PMCID: PMC3678017 DOI: 10.3346/jkms.2013.28.6.955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 02/06/2013] [Indexed: 11/20/2022] Open
Abstract
A 62-yr-old woman with an autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital for further evaluation of intermittent fever, nausea and left flank discomfort. The computed tomography (CT) scan revealed a gas-forming, infectious cyst of approximately 8.1 cm in size in left kidney lower pole. Escherichia coli was identified from the cyst fluid culture examination. Her symptoms improved only after the concomitant use of intravenous ciprofloxacin and an intracystic irrigation of ciprofloxacin through a percutaneous cystostomy drainage. Our case presents the successfully treated emphysematous cyst infection with combination of intravenous antibiotics and intracystic antibiotic therapy instead of surgical management.
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Affiliation(s)
- Hyunsuk Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sunhwa Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jungsil Lee
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Chungyun Cho
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Ki Kim
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Young-Hwan Hwang
- Division of Nephrology, Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea
| | - Kook-Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Curie Ahn
- Division of Nephrology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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14
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Himeno A, Suzuki Y, Kawaguchi H, Isozaki T, Suzuki H. Multiple liver cyst infection caused by Salmonella ajiobo in autosomal dominant polycystic kidney disease. J Infect Chemother 2013; 19:530-3. [DOI: 10.1007/s10156-012-0479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022]
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15
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Öncü S, Saylak Ö, Köseoğlu K, Öztürk B, Eşiyok A, Çörekli E, Sakarya S. Renal cyst infection caused by Brucella abortus. Ren Fail 2012; 35:302-4. [PMID: 23176669 DOI: 10.3109/0886022x.2012.743915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 49-year-old man with a medical history of polycystic kidney disease was presented to the emergency department with fever and left flank pain. Abdominal examination revealed an enlarged and painful left kidney. The C-reactive protein level was significantly high and the magnetic resonance imaging revealed areas of abnormal intensity and fluid-fluid levels in renal cysts. Brucella abortus was yielded from both blood and cyst fluid culture. Standard therapy (rifampicin plus doxycycline) of brucellosis was started, but the clinical and laboratory signs subsided after the addition of ciprofloxacin. There was no need for aspiration of infected cyst fluid. Hereby, according to the medical database search, we report that the first renal cyst infection caused by B. abortus was successfully treated with triple antibiotic therapy.
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Affiliation(s)
- Serkan Öncü
- Department of Infectious Diseases and Clinical Microbiology, Adnan Menderes University Medical Faculty, Aydin, Turkey.
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16
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Halvorson CR, Bremmer MS, Jacobs SC. Polycystic kidney disease: inheritance, pathophysiology, prognosis, and treatment. Int J Nephrol Renovasc Dis 2010; 3:69-83. [PMID: 21694932 PMCID: PMC3108786 DOI: 10.2147/ijnrd.s6939] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2010] [Indexed: 01/09/2023] Open
Abstract
Both autosomal dominant and recessive polycystic kidney disease are conditions with severe associated morbidity and mortality. Recent advances in the understanding of the genetic and molecular pathogenesis of both ADPKD and ARPKD have resulted in new, targeted therapies designed to disrupt cell signaling pathways responsible for the abnormal cell proliferation, dedifferentiation, apoptosis, and fluid secretion characteristic of the disease. Herein we review the current understanding of the pathophysiology of these conditions, as well as the current treatments derived from our understanding of the mechanisms of these diseases.
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Affiliation(s)
- Christian R Halvorson
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA.
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17
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Abstract
Because autosomal dominant polycystic kidney disease (ADPKD) is one of the most common genetic abnormalities seen in today's medical practice, many internists will likely treat patients affected by this condition. Genetic abnormalities have been increasingly recognized, and the pathophysiology of the disease is beginning to be unraveled. Because of advances in imaging technology, surrogate markers for disease progression have allowed clinical studies of newer therapeutic agents to proceed. In the near future, therapies for this common genetic disease may be available to either prevent or stabilize the disease course for many affected individuals.
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Affiliation(s)
- William M Bennett
- Northwest Renal Clinic, Transplant Services Legacy Good Samaritan Hospital, Portland, OR 97210, USA.
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18
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Alam A, Perrone RD. Managing Cyst Infections in ADPKD: An Old Problem Looking for New Answers. Clin J Am Soc Nephrol 2009; 4:1154-5. [DOI: 10.2215/cjn.03270509] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Sallée M, Rafat C, Zahar JR, Paulmier B, Grünfeld JP, Knebelmann B, Fakhouri F. Cyst infections in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 2009; 4:1183-9. [PMID: 19470662 DOI: 10.2215/cjn.01870309] [Citation(s) in RCA: 136] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Cyst infection is a complex diagnostic and therapeutic issue in patients with autosomal dominant polycystic kidney disease (ADPKD); however, published data regarding the diagnosis and the management of cyst infections in patients with ADPKD are sparse. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A retrospective study was conducted in a referral center for patients with ADPKD in Paris, France. We identified using a computerized database all patients who had ADPKD and were admitted in the nephrology department of Hôpital Necker between January 1998 and August 2008 with likely or definite renal and/or hepatic cyst infection. Medical files of all included patients were reviewed. RESULTS Among 389 identified patients with ADPKD, 33 (8.4%) had 41 episodes of cyst infection, including eight definite and 33 likely cases. The incidence of cyst infections in patients with ADPKD was 0.01 episode per patient per year. Microbiological documentation was available for 31 episodes (75%), Escherichia coli accounting for 74% of all retrieved bacterial strains. Positron emission tomography scan proved superior to ultrasound, Computed tomography scan, and magnetic resonance imaging for the detection of infected cysts. Clinical efficacy of initial antibiotic treatment was noted in 71% of episodes. Antibiotic treatment modification was more frequently required for patients who were receiving initial monotherapy compared with those who were receiving bitherapy. Large (diameter >5 cm) infected cysts frequently required drainage. CONCLUSIONS Positron emission tomography scan will probably make the diagnosis of cyst infections easier and more accurate. Antibiotic association, including a fluoroquinolone, and the drainage of large infected cysts remain the main treatment for cyst infections.
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Affiliation(s)
- Marion Sallée
- Department of Nephrology, Hôpital Necker, Paris, France
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20
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Akinci D, Turkbey B, Yilmaz R, Akpinar E, Ozmen MN, Akhan O. Percutaneous treatment of pyocystis in patients with autosomal dominant polycystic kidney disease. Cardiovasc Intervent Radiol 2008; 31:926-30. [PMID: 18196333 DOI: 10.1007/s00270-007-9273-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 11/12/2007] [Accepted: 11/28/2007] [Indexed: 11/28/2022]
Abstract
The course of autosomal dominant polycystic kidney disease (ADPKD) is frequently complicated by infection of a cyst within a polycystic kidney, which is a diagnostic and therapeutic dilemma damaging the clinical course of patients. The aim of this study was to demonstrate the safety and efficacy of percutaneous drainage in management of infected cysts in ADPKD patients. Between May 2003 and December 2006, percutaneous drainage was performed in 16 infected renal cysts of four kidneys in three patients (two females, one male), with a mean age of 57.3 years. Cyst dimensions, total amount of drained cyst fluid, catheterization duration, isolated microorganisms, and follow-up duration were recorded. Technical, clinical success rates were 100%; the complication rate was 0%. Diameters of cysts ranged between 3 and 8 cm. Average volume of drained fluid and average duration of catheterization for one cyst were 226 ml and 9.8 days. No recurrence was encountered but one patient (no. 3), who had pyocystis in the right kidney and was treated with catheterization, referred with left flank pain due to pyocystis in her left kidney 3 months later. Follow-up durations were 35, 47, and 11 months for patients 1, 2, and 3, respectively. For patient 3, follow-up duration for the second procedure was 7 months. We conclude that percutaneous drainage with antibiotic therapy should be the initial method in management of infected cysts in ADPKD patients, with high success and low complication rates.
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Affiliation(s)
- Devrim Akinci
- Department of Radiology, Hacettepe University School of Medicine, Sihhiye, 06100, Ankara, Turkey.
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21
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22
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Abstract
Despite an increasing population of patients with chronic renal insufficiency, the literature on the management of urinary tract infections (UTI) in these patients is sparse. Patients with underlying diabetes are a specific population at risk. Antimicrobial treatment of UTI requires adequate serum, renal, parenchymal, and urine concentrations of drugs with antibacterial activity versus the etiologic organism. Sulfamethoxazole and nitrofurantoin are examples of drugs with low and likely inadequate urine concentrations in patients with creatinine clearances of <50 ml/min. Urine concentrations of ciprofloxacin and levofloxacin remain sufficient as renal function fails, whereas the concentrations of gemifloxacin and moxifloxacin are too low to predict efficacy. More investigative work is needed in the management of UTI in patients with poor renal function.
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Affiliation(s)
- David N Gilbert
- Department of Medical Education, Providence Portland Medical Center, 5050 NE Hoyt, Suite 540, Portland, OR 97213, USA.
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23
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Hiyama L, Tang A, Miller LG. Levofloxacin Penetration Into a Renal Cyst in a Patient With Autosomal Dominant Polycystic Kidney Disease. Am J Kidney Dis 2006; 47:e9-13. [PMID: 16377378 DOI: 10.1053/j.ajkd.2005.09.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2005] [Accepted: 09/19/2005] [Indexed: 11/11/2022]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is a common inherited disorder often complicated by cyst infection. Treatment becomes particularly challenging when the culprit organism is resistant to antibiotics known to sufficiently penetrate cysts. We present the case of a patient with ADPKD and suspected cyst infection caused by group B streptococcus who was treated successfully with levofloxacin and ampicillin. Although data support excellent cyst penetration with ciprofloxacin, its gram-positive antimicrobial activity is marginal. The newer quinolones have added gram-positive activity, but little is known about cyst penetration by these antibiotics. We simultaneously measured cyst and serum levels of levofloxacin and ampicillin and found levofloxacin to penetrate cysts well. Therefore, levofloxacin may be useful in the management of renal cyst infection, particularly for the treatment of gram-positive organisms.
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24
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Grantham JJ, Chapman AB, Torres VE. Volume Progression in Autosomal Dominant Polycystic Kidney Disease: The Major Factor Determining Clinical Outcomes. Clin J Am Soc Nephrol 2005; 1:148-57. [PMID: 17699202 DOI: 10.2215/cjn.00330705] [Citation(s) in RCA: 198] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autosomal dominant polycystic kidney disease (PKD) is a hereditary condition characterized by the progressive enlargement of innumerable renal cysts that contribute to life-altering morbidity early in the course of the disease. Evidence indicates that the rate of increase in kidney volume can be reliably measured by magnetic resonance or computed tomography imaging, thus providing objective means to judge the effectiveness of therapies that are targeted to the aberrant growth of renal tubules. It is now possible, therefore, to monitor the effectiveness of potential therapies on the signature abnormality in autosomal dominant PKD before irreversible damage has been done by the cysts. Evidence accumulated from human cross-sectional and longitudinal studies and longitudinal studies of PKD models in animals provide strong support for the view that reducing the rate of kidney volume enlargement will ameliorate the late-stage development of renal insufficiency.
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25
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Abstract
Patients with chronic kidney disease (CKD) are at high risk for adverse drug reactions and drug-drug interactions. Drug dosing in these patients often proves to be a difficult task. Renal dysfunction-induced changes in human pathophysiology regularly results may alter medication pharmacodynamics and handling. Several pharmacokinetic parameters are adversely affected by CKD, secondary to a reduced oral absorption and glomerular filtration; altered tubular secretion; and reabsorption and changes in intestinal, hepatic, and renal metabolism. In general, drug dosing can be accomplished by multiple methods; however, the most common recommendations are often to reduce the dose or expand the dosing interval, or use both methods simultaneously. Some medications need to be avoided all together in CKD either because of lack of efficacy or increased risk of toxicity. Nevertheless, specific recommendations are available for dosing of certain medications and are an important resource, because most are based on clinical or pharmacokinetic trials.
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Affiliation(s)
- Steven Gabardi
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115-6110, USA.
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26
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Abstract
Collated in this highly personal commentary are the most important research findings of the past 10 years that deal primarily with the renal manifestations of inherited polycystic kidney diseases. Progress in understanding these complex disorders has followed two major concurrent and convergent lines of investigation: genes and genetic mechanisms, and pathogenesis and progression. The field has moved from descriptive pathobiology to the elucidation of molecular mechanisms consequent to genetic and epigenetic events. Doubtless, the favorite works of some who have labored diligently in this field have not been fully exalted, and for this I apologize. Were I the editor, this entire celebratory volume would be used to extol the thrilling growth of knowledge during the tenure of this polycystic kidney disease watcher.
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Affiliation(s)
- J J Grantham
- Department of Internal Medicine, Biochemistry and Molecular Biology, Kidney Institute, Kansas University Medical Center, Kansas City, Kansas, USA.
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27
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Norby SM, Torres VE. Complications of autosomal dominant polycystic kidney disease in hemodialysis patients. Semin Dial 2000; 13:30-5. [PMID: 10740669 DOI: 10.1046/j.1525-139x.2000.00010.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- S M Norby
- Department of Nephrology/Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Fleming TW, Barry JM. Bilateral open transperitoneal cyst reduction surgery for autosomal dominant polycystic kidney disease. J Urol 1998; 159:44-7. [PMID: 9400433 DOI: 10.1016/s0022-5347(01)64007-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE We reviewed our experience with open transperitoneal bilateral renal cyst reduction surgery in patients with symptomatic autosomal dominant polycystic kidney disease to define perioperative morbidity and mortality, and to suggest that others consider this mode of therapy when more conservative methods fail to provide relief from pain or early satiety. MATERIALS AND METHODS A total of 28 patients underwent 30 transperitoneal bilateral renal cyst reduction decompression operations between May 1987 and June 1996. Ten procedures included surgical treatment of concomitant liver cysts (8 by liver cyst marsupialization and 2 by partial hepatic resection). Records were reviewed for hospital stay, perioperative morbidity, changes in renal function and hypertension control. RESULTS Hospitalization averaged 9 days. Treatment of hepatic cysts, age and renal insufficiency did not extend hospitalization. A transient reduction in renal function occurred after 20 procedures. The most frequently encountered perioperative morbid events were ileus in 4 patients and cardiac arrhythmias in 3. The most significant complications were myocardial infarction in 1 patient and fatal adult respiratory distress syndrome after partial liver resection in another. Preoperative renal insufficiency, age and treatment of hepatic cysts were not associated with increased morbidity. Six patients had improvement in hypertension and none had sepsis. CONCLUSIONS Bilateral transperitoneal renal cyst reduction surgery is a relatively safe and effective treatment for individuals with symptomatic polycystic kidney disease in whom more conservative therapies have failed.
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Affiliation(s)
- T W Fleming
- Division of Urology, Oregon Health Sciences University, Portland, USA
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29
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Abstract
Once viewed as hopelessly incurable disorders and the dustbin for careers in academic medicine, the polycystic kidney diseases have emerged as prime targets of pathophysiologic study and palliative and definitive treatment in the era of molecular medicine. Polycystic kidney disease (PKD) may be hereditary or acquired. The major inherited types are autosomal dominant (AD) and autosomal recessive (AR). ADPKD is caused by at least two (and possibly three) genes located on separate chromosomes, while ADPKD-1 is due to a 14 kb transcript in a duplicated region on the short arm of chromosome 16 very near the alpha-globin gene cluster and the gene for one form of tuberous sclerosis. ADPKD-2 has been assigned to the long arm of chromosome 4. ARPKD is due to a mutated gene on both copies of the long arm of chromosome 6. Cysts originate in renal tubules. Proliferation of tubule epithelial cells modulated by endocrine, paracrine, and autocrine factors is a major element in the pathogenesis of renal cystic diseases. In addition, fluid that is abnormally accumulated within the cysts is derived from glomerular filtrate and, to a greater extent, by transepithelial fluid secretion. Abnormal synthesis and degradation of matrix components associated with interstitial inflammation are additional features in the pathogenesis of renal cystic diseases. The ADPKD genotypes are characterized by bilateral kidney cysts, hypertension, hematuria, renal infection, stones, and renal insufficiency. ADPKD is a systemic disorder; cysts appear with decreasing frequency in the kidneys, liver, pancreas, brain, spleen, ovaries, and testis. Cardiac valvular disorders, abdominal and inguinal hernias, and aneurysms of cerebral and coronary arteries and aorta are also associated with ADPKD. Treatment is supportive: dietary regulation of salt and protein intake, control of hypertension and renal stones, and dialysis and transplantation at the end stage. ARPKD is a relatively rare disease that causes clinical symptoms at birth, with significant mortality in the first month of life. The cysts develop primarily in the collecting ducts because of a failure in the maturation process. Early complications include Potter's syndrome; excessive size of the kidneys, causing respiratory dysfunction; hypertension; and renal insufficiency. Hepatic fibrosis is an associated extrarenal problem that results in significant morbidity in young children and adolescents. Treatment includes supportive care, dialysis, and renal transplantation. Acquired cysts (solitary/simple) are commonplace in older persons. Multiple cysts may be seen in association with potassium deficiency, congenital disorders, metabolic diseases, and toxic renal injury.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- J R Martinez
- Department of Medicine, University of Kansas Medical Center, Kansas City, USA
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30
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Abstract
Renal cystic disease is a relatively common disorder whose development and progression currently appear to be due to an interaction between an abnormal basement membrane matrix, a potentially immature, hyperproliferative epithelium, and an abnormal epithelial secretory apparatus. RCC risk in cystic kidneys is the most controversial sequela of PKD. Currently, RCC risk in ESRD patients appears to be close to that present in the general population and only coincidentally associated with renal cysts. Screening of all ESRD patients for RCC and prophylactic native nephrectomy in dialysis and transplant patients does not seem to be indicated.
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Affiliation(s)
- G A Anderson
- Department of Urology, Medical College of Wisconsin, Milwaukee
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31
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Affiliation(s)
- P A Gabow
- Department of Medicine, University of Colorado Health Sciences Center, Denver 80262
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32
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Rossi SJ, Healy DP, Savani DV, Deepe G. High-dose ciprofloxacin in the treatment of a renal cyst infection. Ann Pharmacother 1993; 27:38-9. [PMID: 8431617 DOI: 10.1177/106002809302700109] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To report a case of renal cyst infection successfully treated with ciprofloxacin. CASE SUMMARY The clinical course of a 33-year-old woman with radiologic and symptomatic evidence of a renal cyst infection continued to worsen after 7 days of apparently adequate antibiotic therapy for Escherichia coli isolated from her urine. Antibiotic therapy with intravenous ciprofloxacin 600 mg every 12 hours was administered for 7 days and then given as oral therapy (750 mg q12h) for another 14 days. The patient's clinical condition rapidly improved on ciprofloxacin and follow-up 28 days later showed no evidence of infection. DISCUSSION Renal cyst infections are a serious complication of polycystic kidney disease and are often refractory to standard antimicrobial therapy. Ciprofloxacin has the chemical properties and antimicrobial activity needed to treat these infections. Previously reported concentrations of ciprofloxacin in renal cyst fluid are therapeutic for the common pathogens associated with renal cyst infections. CONCLUSIONS Ciprofloxacin appears to be a safe and effective option for treating renal cyst infections. Further controlled studies evaluating its clinical efficacy are warranted.
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Affiliation(s)
- S J Rossi
- Antimicrobial Research Unit, College of Pharmacy, Cincinnati, OH
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33
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Bennett WM, Elzinga LW, Barry JM. Polycystic kidney disease: II. Diagnosis and management. HOSPITAL PRACTICE (OFFICE ED.) 1992; 27:61-4, 69-72. [PMID: 1560079 DOI: 10.1080/21548331.1992.11705399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ongoing research will no doubt change the way we diagnose and manage cystic kidney diseases in the not-too-distant future (probably before the turn of the century). The immediate clinical benefits are the more modest: Genetic tests have not replaced imaging techniques for the diagnosis of ADPKD, and clinical management of all cystic kidney diseases is still largely empiric.
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Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common genetic disease, affecting a half million Americans. The clinical phenotype can result from at least two different gene defects. One gene that can cause ADPKD has been located on the short arm of chromosome 16. This discovery has made possible new methods for diagnosing the disorder in gene carriers prior to the development of renal cysts. Although renal cysts are clearly an important manifestation of the gene defect, other systemic manifestations are both common and clinically important. Cardiac valvular lesions, intracranial aneurysms, hepatic cysts, and diverticula are included in the array of systemic manifestations. Moreover, renal cysts are only one of a myriad of renal manifestations. Although ADPKD was long considered an adult cystic disease, it is also a common cause of childhood cystic disease and must be considered in the differential diagnosis in that setting.
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Affiliation(s)
- P A Gabow
- Denver General Hospital, University of Colorado Health Sciences Center
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35
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Percutaneous cyst puncture in the treatment of cyst infection in autosomal dominant polycystic kidney disease. Am J Kidney Dis 1990; 16:252-5. [PMID: 2399917 DOI: 10.1016/s0272-6386(12)81025-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cyst infection in autosomal dominant polycystic kidney disease (ADPKD) poses a difficult diagnostic and therapeutic problem. We describe a serious indolent cyst infection due to Staphylococcus aureus, which was successfully diagnosed and treated with repeated percutaneous cyst drainage and intravenous (IV) antibiotic therapy. Cyst aspiration also permitted monitoring of cyst antibiotic levels and evidence of active infection.
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Telenti A, Torres VE, Gross JB, Van Scoy RE, Brown ML, Hattery RR. Hepatic cyst infection in autosomal dominant polycystic kidney disease. Mayo Clin Proc 1990; 65:933-42. [PMID: 2198396 DOI: 10.1016/s0025-6196(12)65154-4] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
To characterize the syndrome of hepatic cyst infection in autosomal dominant polycystic kidney disease (ADPKD) and to review its diagnosis and management, we retrospectively studied five such cases in patients from our institution and nine detailed case reports from the literature. The clinical manifestations were an acute (58%) or subacute (42%) febrile illness, typically associated with tenderness in the right upper quadrant, leukocytosis, a very high erythrocyte sedimentation rate, but minor abnormalities of liver function tests. Bacteremia was present in 7 of 11 patients. Enterobacteriaceae grew in pure culture from the cyst fluid in 9 of 12 patients. Complex cysts were observed by ultrasonography (in four of eight patients), computed tomography (in six of nine), and magnetic resonance imaging (in two of two). 111In leukocyte scans were positive in all four patients in whom they were done, and 67Ga scans were positive in only one of three patients. An unfavorable outcome was observed in six of seven patients treated with only antibiotics, in contrast with one of seven patients who received antibiotics and early drainage. In two patients, ciprofloxacin cyst levels were 2.3 and 4.8 times higher than the level in serum; in a third patient, cyst levels remained in therapeutic range 30 hours after the last dose of ciprofloxacin, at which time serum levels were undetectable. Clinical and laboratory features and the use of modern scanning techniques facilitate a prompt diagnosis of infection in hepatic cysts in ADPKD. The treatment of choice is a combination of percutaneous drainage and antimicrobial therapy.
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Affiliation(s)
- A Telenti
- Division of Infectious Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
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Affiliation(s)
- J J Grantham
- Department of Medicine, University of Kansas School of Medicine, Kansas City 66103
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