Urinary tract infection in autosomal dominant polycystic kidney disease
- Arlene B Chapman, MD
Arlene B Chapman, MD
- Professor of Medicine
- University of Chicago Pritzker School of Medicine
- Frederic F Rahbari-Oskoui, MD, MSCR
Frederic F Rahbari-Oskoui, MD, MSCR
- Associate Professor of Medicine
- Emory University School of Medicine
- William M Bennett, MD
William M Bennett, MD
- Medical Director
- Legacy Good Samaritan Transplant Services
Approximately 30 to 50 percent of patients with autosomal dominant polycystic kidney disease (ADPKD) will have a urinary tract infection (UTI) during their lifetime. Cyst infections responsible for hospitalization occur much less frequently (approximately 9 percent) [1,2]. An infected cyst and acute pyelonephritis are the most common kidney infections, although complications such as a perinephric abscess and bacteremia can occur [3,4]. Cyst infection incidence rates are approximately 0.01 episode per patient per year . Even nonfunctional end-stage polycystic kidneys may be a source of infection . After transplantation, special attention needs to be paid to the native kidneys and polycystic livers in patients who present with sepsis, fever, or flank or abdominal tenderness.
By convention, UTI is defined either as a lower tract (acute cystitis) or upper tract (acute pyelonephritis) infection. This topic will review issues related to UTIs, particularly upper tract infections, in patients with ADPKD. Discussions related to UTI in patients without ADPKD, as well as the therapy of ADPKD and other renal manifestations of ADPKD, can be found separately. (See "Course and treatment of autosomal dominant polycystic kidney disease" and "Renal manifestations of autosomal dominant polycystic kidney disease" and "Acute uncomplicated cystitis and pyelonephritis in women" and "Acute complicated cystitis and pyelonephritis", section on 'Pyelonephritis'.)
SOURCE OF INFECTION
As with UTIs in the general population, UTIs in patients with ADPKD are more likely to occur in women [3,6-8]. The infections are typically caused by gram-negative enteric organisms.
With respect to upper tract infections:
●Gram-negative enteric organisms ascend from the bladder among patients with pyelonephritis [3,6-8]. Such infections may be associated with dysuria and frequency due to bladder infection.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Sallée M, Rafat C, Zahar JR, et al. Cyst infections in patients with autosomal dominant polycystic kidney disease. Clin J Am Soc Nephrol 2009; 4:1183.
- Hwang JH, Park HC, Jeong JC, et al. Chronic asymptomatic pyuria precedes overt urinary tract infection and deterioration of renal function in autosomal dominant polycystic kidney disease. BMC Nephrol 2013; 14:1.
- Sklar AH, Caruana RJ, Lammers JE, Strauser GD. Renal infections in autosomal dominant polycystic kidney disease. Am J Kidney Dis 1987; 10:81.
- Gibson P, Watson ML. Cyst infection in polycystic kidney disease: a clinical challenge. Nephrol Dial Transplant 1998; 13:2455.
- Stiasny B, Ziebell D, Graf S, et al. Clinical aspects of renal transplantation in polycystic kidney disease. Clin Nephrol 2002; 58:16.
- Schwab SJ, Bander SJ, Klahr S. Renal infection in autosomal dominant polycystic kidney disease. Am J Med 1987; 82:714.
- Gabow PA, Bennett WM. Renal manifestations: complication management and long-term outcome of autosomal dominant polycystic kidney disease. Semin Nephrol 1991; 11:643.
- Milutinovic J, Fialkow PJ, Agodoa LY, et al. Autosomal dominant polycystic kidney disease: symptoms and clinical findings. Q J Med 1984; 53:511.
- Chapman AB, Thickman D, Gabow PA. Percutaneous cyst puncture in the treatment of cyst infection in autosomal dominant polycystic kidney disease. Am J Kidney Dis 1990; 16:252.
- Rizk D, Chapman AB. Cystic and inherited kidney diseases. Am J Kidney Dis 2003; 42:1305.
- Salehipour M, Jalaeian H, Salahi H, et al. Are large nonfunctional kidneys risk factors for posttransplantation urinary tract infection in patients with end-stage renal disease due to autosomal dominant polycystic kidney disease? Transplant Proc 2007; 39:887.
- Bleeker-Rovers CP, de Sévaux RG, van Hamersvelt HW, et al. Diagnosis of renal and hepatic cyst infections by 18-F-fluorodeoxyglucose positron emission tomography in autosomal dominant polycystic kidney disease. Am J Kidney Dis 2003; 41:E18.
- Desouza RM, Prachalias A, Srinivasan P, et al. Differentiation between infection in kidney and liver cysts in autosomal dominant polycystic kidney disease: use of PET-CT in diagnosis and to guide management. Transplant Proc 2009; 41:1942.
- Migali G, Annet L, Lonneux M, Devuyst O. Renal cyst infection in autosomal dominant polycystic kidney disease. Nephrol Dial Transplant 2008; 23:404.
- Lantinga MA, Drenth JP, Gevers TJ. Diagnostic criteria in renal and hepatic cyst infection. Nephrol Dial Transplant 2015; 30:744.
- Grantham JJ, Geiser JL, Evan AP. Cyst formation and growth in autosomal dominant polycystic kidney disease. Kidney Int 1987; 31:1145.
- Bennett WM, Elzinga L, Pulliam JP, et al. Cyst fluid antibiotic concentrations in autosomal-dominant polycystic kidney disease. Am J Kidney Dis 1985; 6:400.
- Elzinga LW, Golper TA, Rashad AL, et al. Trimethoprim-sulfamethoxazole in cyst fluid from autosomal dominant polycystic kidneys. Kidney Int 1987; 32:884.
- Schwab SJ, Weaver ME. Penetration of trimethoprim and sulfamethoxazole into cysts in a patient with autosomal-dominant polycystic kidney disease. Am J Kidney Dis 1986; 7:434.
- Elzinga LW, Golper TA, Rashad AL, et al. Ciprofloxacin activity in cyst fluid from polycystic kidneys. Antimicrob Agents Chemother 1988; 32:844.
- 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.
- Van Zijl PS, Chai TC. Gas-forming infection from Clostridium perfringens in a renal cyst of a patient with autosomal dominant polycystic kidney disease. Urology 2004; 63:1178.
- Akinci D, Turkbey B, Yilmaz R, et al. Percutaneous treatment of pyocystis in patients with autosomal dominant polycystic kidney disease. Cardiovasc Intervent Radiol 2008; 31:926.
- Rozanski J, Kozlowska I, Myslak M, et al. Pretransplant nephrectomy in patients with autosomal dominant polycystic kidney disease. Transplant Proc 2005; 37:666.