Palabras clave
cistitis
infección de vías urinarias
trasplante renal
insuficiencia renal crónica
hematuria
Cómo citar
Resumen
Contexto: la infección de vías urinarias (IVU), causada por adenovirus (ADV) posterior al trasplante renal, tiene el potencial de causar disfunción o pérdida del injerto. La presentación clínica es variable y el tratamiento difiere según la disponibilidad de medicamentos en el medio y la experiencia clínica.
Objetivo: el estudio describe las características clínicas, de laboratorio y la respuesta al tratamiento de una serie de casos de pacientes trasplantados renales con IVU por ADV en un hospital de Cali, Colombia.
Metodología: estudio retrospectivo que incluye a todos los pacientes adultos trasplantados con diagnóstico de IVU por ADV entre enero del 2015 hasta enero del 2021. El diagnóstico se realizó basado en la clínica, el resultado positivo de la prueba de reacción de cadena de polimerasa (PCR) y la carga viral del ADV.
Resultados: de 256 pacientes trasplantados, ocho presentaron diagnóstico de cistitis hemorrágica o nefritis intersticial secundaria a infección por ADV. Se presentó de forma temprana (? 3 meses) en el 62?% de los casos, quienes debutaron con macrohematuria asociada a piuria estéril y linfopenia. Por otra parte, se presentó alteración en la función renal en el 87,5?% de los casos y la reducción de la inmunosupresión fue el pilar fundamental en el manejo clínico.
Conclusiones: el reconocimiento de la infección por ADV en pacientes trasplantados renales ha ido en aumento. La sospecha clínica es clave para el diagnóstico (macrohematuria, síntomas urinarios irritativos y falla renal) y la reducción de la dosis de inmunosupresión para restaurar la función inmune puede ser suficiente en la resolución de la infección y la reversión de la disfunción renal.
Citas
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