Chronic Pyelonephritis: a Unknown Cause of Kidney Transplant Loss

Abstract

Chronic pyelonephritis: a misunderstood cause of renal allograft loss Although urinary tract infections (UTI) are the most frequent infections in kidney transplant patients, there are no sufficient data about the prevalence of acute and chronic pyelonephritis and organ or patient survival. We present the clinical case of a young woman with a kidney transplant admitted to our Nephrology Clinic because of an acute worsening of renal function and a history of recurrent UTI. The renal biopsy showed medullary tissue with a severe tubule-interstitial damage, suggestive for acute rejection, insomuch that steroids were prescribed. Due to the lack of any clinical improvement, a second biopsy was performed, showing a histological picture of chronic pyelonephritis with a severe and advanced damage. Subsequently, because of the severe renal failure the patient underwent peritoneal dialysis and transplant nephrectomy. This clinical case is exemplificative of the possible adverse outcomes of recurrent UTI that might lead in a short time to organ failure, highlighting the importance of a definitive histologic diagnosis.