Chronic asymptomatic pyuria precedes overt urinary tract infection and deterioration of renal function in autosomal dominant polycystic kidney disease

BMC Nephrology

Curie Ahn³  Young-Hwan Hwang⁶  Kook-Hwan Oh²  Jaeseok Yang³  Suk Hee Yu⁴  Jeong Yeon Cho¹  Kitae Bang⁷  Mi Yeun Han²  Seon ha Baek²  Jong Cheol Jeong²  Hayne Cho Park⁵  Jin Ho Hwang² 

[1] Department of Radiology, Seoul National University Hospital, Seoul, South Korea;Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-no, Jongno-gu, Seoul, 110-744, South Korea;Transplantation Center, Seoul National University Hospital, Seoul, South Korea;Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea;Research Center for Rare Diseases, Seoul National University Hospital, Seoul, South Korea;Department of Internal Medicine, Eulji General Hospital, Seoul, South Korea;Department of Internal Medicine, Daejeon Eulji University Hospital, Daejeon, South Korea

关键词: Urinary tract infection;    Pyuria;    Glomerular filtration rate;    Chronic renal failure;    Polycystic kidney disease;   

Others  :  1083037
DOI  :  10.1186/1471-2369-14-1

 received in 2012-06-21, accepted in 2012-12-19,  发布年份 2013

【 摘 要 】

Background

Urinary tract infection (UTI) occurs in 30%-50% of individuals with autosomal dominant polycystic kidney disease (ADPKD). However, the clinical relevance of asymptomatic pyuria in ADPKD patients remains unknown.

Methods

We retrospectively reviewed medical records of 256 ADPKD patients who registered to the ADPKD clinic at Seoul National University Hospital from Aug 1999 to Aug 2010. We defined the asymptomatic pyuria as more than 5-9 white blood cells in high-power field with no related symptoms or signs of overt UTI. Patients were categorized into 2 groups depending on its duration and frequency: Group A included non-pyuria and transient pyuria patients; Group B included recurrent and persistent pyuria patients. The association between asymptomatic pyuria and both the development of overt UTI and the deterioration of renal function were examined.

Results

With a mean follow-up duration of 65.3 months, 176 (68.8%) out of 256 patients experienced 681 episodes of asymptomatic pyuria and 50 episodes of UTI. The annual incidence of asymptomatic pyuria was 0.492 episodes/patient/year. The patients in group B showed female predominance (58.5% vs. 42.0%, P=0.01) and experienced an upper UTI more frequently (hazard ratio: 4.612, 95% confidence interval: 1.735-12.258; P=0.002, adjusted for gender and hypertension). The annual change in estimated glomerular filtration rate (ΔeGFR) was significantly larger in magnitude in group B than in group A (-2.7±4.56 vs. -1.17±5.8, respectively; P=0.01). Age and Group B found to be the independent variables for ΔeGFR and developing end-stage renal disease (16.0% vs. 4.3%, respectively; P=0.001).

Conclusions

Chronic asymptomatic pyuria may increase the risk of developing overt UTI and may contribute to declining renal function in ADPKD.

【 授权许可】

   
2013 Hwang et al.; licensee BioMed Central Ltd.

【 图 表 】

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