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제목	The Effect of APN in Kidney Transplantation Patients
저자	Seon Deok Hwang, Byung Ha Chung, Bum Soon Choi,Cheol Whee Park, Yong-Soo Kim, Chul Woo Yang
출판정보	2014; 2014(1):
키워드	급성신우신염, 신장이식
초록	Background: Urinary tract infection (UTI) and acute pyelonephritis (APN) were most frequently occurring infection in kidney transplantation. But the influence of acute graft pyelonephritis (AGPN) on graft outcome in renal transplant recipients still remains unclear. The aim of this study was to evaluate pathologic and clinical features that develop acute pyelonephritis after kidney transplantation (KTx) and to identify the factors associated with acute pyelonephritis and its impact on graft function. Methods: Between 2009 and 2014, 625 kidney transplants were performed at our hospital. We retrospectively analyzed the clinical and histological data of 12 APN patients after kidney transplantation. Result: The biopsies were performed at a median time of 71.79±85.7 months after renal transplantation. The indications for biopsy were elevated serum creatinine (Scr) level in 10 cases. At the time of biopsy, Scr level was 2.37± 1.21 mg/dL, and MDRD eGFR was 35.67±23.83 mL/min/1.73m2. The most common diagnosis was glomerulonephritis (GN) about 7 cases. Histopathological findings are neutrophilic infiltration in 66.6% (8/12), interstitial fibrosis in 91.6% (11/12), Mononuclear cell infiltration in 91.6% (11/12), tubulitis in 75% (9/12) and Tubular cast (neutriphilic) in 91.6% (11/12). Typical calcineurin inhibitor (CNI)-induced nephrotoxicity was detected in 2 cases (16.6%). Immunofluorescence study were IgA, IgM and C3 in 50% (6/12). Recurrent prior UTI was 6 cases (50%). When We compare with One month ago of biopsy, no difference MDRD GFR at biopsy time but 1,3 and 6 month after kidney biopsy was signicantly decreased GFR. We began treatment for renal impairment based on the result of clinically proper treatment Renal impairment did not improve and progressed to end-stage renal disease in 4 cases. These patients required hemodialysis (3 cases) and peritoneal dialysis (1 case). Conclusion: Acute pyelonephritis decreased renal allograft function and it seems to be high risk graft failure.
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