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Previous issue date: 2007 / Introdução: De acordo com estudos retrospectivos previos, a candiduria ocorre em 11 a 20 por cento de todos os pacientes transplantados renais. Contudo, existe pouco conhecimento sobre a sua incidencia em estudos prospectivos, as suas caracteristicas clinico-¬epidemiologicas, e a sua repercussao na funcao do enxerto em curto prazo. Objetivos: Descrever a incidencia, etiologia, caracteristicas clinico-laboratoriais, repercussao na funcao do enxerto, e fatores de risco para candiduria nos dois primeiros meses pos¬ transplante renal. Casuistica e Metodos: Estudo observacional prospectivo realizado entre Agosto de 2005 e Julio de 2006. Incluiram-se 67 adultos transplantados renais no Hospital do Rim e Hipertensao, mantendo-se a proporcao de 30 por cento de receptores de transplantes de doador falecido. Os pacientes foram acompanhados clinicamente uma vez por semana durante o primeiro mes e a cada 15 dias durante o segundo mes pos-transplante. Duas uroculturas consecutivas, com intervalo de no maximo 24 horas, foram obtidas em cada uma das seis visitas programadas para coleta (semanas 1, 2, 3, 4, 6 e 8 pos-transplante). Culturas quantitativas para bacterias e fungos foram realizadas simultaneamente. Realizaram-se tambem exame do sedimento urinario, bioquimica sanguinea e hemograma. A associacao de variaveis com predicao de candiduria foi incluida em um modelo de regressao logistica multipla. Resultados: A candiduria ocorreu em 36 por cento dos pacientes, com um total de 30 episodios e uma media de 1.25 episodios por paciente. O tempo medio de aparecimento foi de 24 dias. C. albicans foi o agente mais comumente isolado (67 por cento). Noventa por cento dos episodios foram as sintomaticos e vinte por cento tiveram aumento de creatinina de 0,13 mg/dl em media. Oitenta por cento dos episodios nao receberam tratamento antifungico, e a candiduria desapareceu em 50 por cento dos episodios nao tratados. Nao houve complicacoes relacionadas com a candiduria mesmo em pacientes com episodios persistentes. As medias de creatinina e depuracao de creatinina em pacientes nao tratados, nao mostraram diferencas estatisticamente significantes entre o dia 7 e o dia 15 apos o aparecimento da candiduria. A unica variavel independentemente relacionada com candiduria foi o uso previo de sonda vesical (OR=14; IC95 por cento: 3,4-60,9; p=0,0000). Conclusoes: A candiduria foi um evento frequente, com uma incidencia de 36 por cento, superior a relatada em estudos retrospectivos previos. Apresentou-se mais frequentemente de forma assintomatica e benigna, sem repercussao na funcao do enxerto em curto prazo e nao esteve associada a complicacoes como candidemia, uropatia obstrutiva, pielonefrite e bola fungica. O uso de sonda vesical no mes anterior a candiduria foi fator preditivo independente para candiduria / Background: Candiduria is estimated to occur in 11-20% of all kidney transplant patients according to retrospective studies. However, little is known regarding incidence in prospective studies as well as clinical and epidemiological characteristics and its shortterm impact on graft function. Objective: To describe the incidence, etiology, clinical and laboratorial characteristics, impact on graft function and risk factors for candiduria in the
first two months after renal transplantation. Methods: Observational prospective study conducted from August 2005 to July 2006. Sixty seven kidney transplant adults in the Hospital do Rim e Hipertensão were included, keeping the proportion of 30% of deceaseddonor transplantation recipients. Patients were assessed clinically once weekly during the
first month and every other week during the second month. Two consecutive urine cultures
were performed at least 24 h apart, in each of the six scheduled visits for collection (weeks
1,2,3,4,6 and 8 after transplantation). Quantitative cultures both bacteria and yeasts were
performed together. Urinalysis, hematological studies and serum chemistries were also
performed. The association of variables with prediction to candiduria was included in a
stepwise logistic regression model. Results: Candiduria occurred in 36% of the patients,
with a total of 30 episodes and a mean of 1.25 episodes per patient. The first episode of
candiduria was detected a mean of 24 days after transplantation. C. albicans was the most
frequently isolated agent (67%). Ninety percent of all episodes were asymptomatic and
twenty percent had a mean creatinine increase of 0.13 mg/dl. Eighty percent of episodes
did not receive antifungal treatment and candiduria resolved in 50% of untreated episodes.
There were no complications related to candiduria even in patients with persistent
episodes. Mean serum creatinine value and mean creatinine clearance level in untreated
episodes did not show significant statistically differences between day 7 and day 15 after
candiduria appearance. The only variables independently related to candiduria was the
previous use of an indwelling bladder catheter (OR=14, CI: 3.4-60.9, p=0,0000).
Conclusions candiduria was a common event, with incidence of 36% and higher than
reported by retrospective studies. Most episodes of candiduria were asymptomatic and
candiduria is usually benign, without short-term repercussion on graft function and not
associated to complications such as candidemia, obstructive uropathy, pyelonephritis and
fungal ball. The use of an indwelling bladder catheter in the month before occurrence of
candiduria was an independently predictive factor for candiduria. / BV UNIFESP: Teses e dissertações
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.unifesp.br:11600/23436 |
| Date | January 2007 |
| Creators | Castañeda Barragan, Carlos Gabriel [UNIFESP] |
| Contributors | Universidade Federal de São Paulo (UNIFESP), Camargo, Luis Fernando Aranha [UNIFESP] |
| Publisher | Universidade Federal de São Paulo (UNIFESP) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | 90 f. |
| Source | reponame:Repositório Institucional da UNIFESP, instname:Universidade Federal de São Paulo, instacron:UNIFESP |
| Rights | info:eu-repo/semantics/openAccess |
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