Kidney Transplant Candidate With Persistent Bacteruria
A 45-year-old woman with end-stage renal disease who is waiting for a kidney transplant is having asymptomatic, persistent, significant Escherichia coli bacteriuria, which is not clearing even with repeated courses of adequate and appropriate antibiotics. There is no anatomic anomaly or stone in the urinary tract. How should we proceed? Can she be transplanted under antibiotic coverage (one reported to be sensitive) or should we wait until her urine becomes culture-free?


Kannan Nephro


This is a patient with persistent Escherichia coli bacteriuria who is a candidate for kidney transplantation and was treated with repeated courses of antibiotics. No anatomic abnormality or stones were found. I assume that vesicoureteral reflux was ruled out by urologic investigation. It would also be important to make sure that the native kidneys are not the source of this persistent bacteriuria. I recall cases in which the focus was found in one of the native kidneys. This was diagnosed by sampling of the urine separately from each side by urologic procedure. In some cases, nephrectomy of the native kidney(s) was performed to eliminate this problem. If there is a focus of bacteria, it may also infect the transplanted organ. In general, we attempt to clear bacteria from the urine before transplantation for the same reason.