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Renal transplantation in children with occult neurogenic bladders drained by intermittent self catheterisation
Insights
Renal transplantation is viable for children with neurogenic bladders. With proper intermittent self-catheterization and antibiotic prophylaxis, urinary tract infections do not impede renal function post-transplant.
Area of Science:
- Pediatric Nephrology
- Urology
- Transplantation Immunology
Background:
- Children with neurogenic bladders often face urinary tract infections, complicating renal transplantation eligibility.
- Previous concerns centered on infection risks associated with chronic urinary stasis in these patients.
Observation:
- Two pediatric patients with occult neurogenic bladders received renal transplants.
- Both patients practiced intermittent self-catheterization and received prophylactic antibiotics post-transplant.
- Despite experiencing infections, no significant decline in renal function was observed.
Findings:
- One patient's renal function temporarily declined due to infrequent catheterization, but improved with increased frequency.
- Adequate intermittent self-catheterization and urinary chemoprophylaxis effectively managed infection risks.
- No infections led to irreversible renal function deterioration.
Implications:
- Renal transplantation can be a safe and effective option for children with bladder dysfunction.
- Optimized catheterization protocols and prophylactic measures are crucial for successful outcomes.
- This study challenges previous contraindications for renal transplantation in this patient population.
Abstract:
Children with neurogenic bladders have usually not been considered for renal transplantation because of the potential complications caused by chronic infections of the urinary tract. Two girls with occult neurogenic bladders who were practising intermittent self catheterisation were given renal transplants. Both took prophylactic antibacterial agents after transplantation, and both experienced infections at some stage, but none of these infections produced a deterioration in renal function. In one patient creatinine clearance fell and signs of obstruction appeared, but this was because the patient had been catheterising herself only two or three times a week. When she resumed catheterisation four times a day creatinine clearance rose and the urographic and renographic appearances returned to normal. These results suggest that, with adequate catheterisation and urinary chemoprophylaxis, infection is not a particular problem in children with bladder dysfunction who undergo renal transplantation.