Impact of febrile infections on the long-term function of kidney allografts

Purpose: We prospectively determined the impact of febrile infectious disea se on long-term renal graft function compared with a matched control group. Materials and Methods: Included in our study were 39 patients who presented with episodes of febrile infection with body temperature greater than 38C on 2 consecutive occasions, necessitating hospitalization. In addition, 39 controls without febrile infection requiring hospitalization within 2 month s were chosen from the complete data pool of all renal transplant recipient s followed at our transplant clinic using the matched pair technique. Renal function was estimated by serum creatinine and calculated creatinine clear ance. Results: Of the 39 patients with infection 15 had urinary tract infection a nd 24 had other, mostly bacterial infection, including pneumonia/severe bro nchitis in 12, oral/dental infection in 2, gastroenteritis in 2, shunt seps is in 1, herpes zoster in 1, cytomegalovirus in 1 and other in 5. Mean esti mated creatinine clearance plus or minus standard deviation was similar in the infection and control groups at the beginning of the study (51 +/- 22 a nd 51 +/- 23 ml. per minute, respectively). During the infectious episode m ean creatinine clearance significantly decreased to 38 +/- 17 ml. per minut e in the infection group. After infection resolved creatinine clearance ret urned to an almost baseline mean value of 50 +/- 23 ml. per minute. However , after 2 years of followup there was a significant difference in mean crea tinine clearance in the infection group versus controls (45 +/- 25 versus 5 2 +/- 25 ml. per minute, p = 0.022). Conclusions: To our knowledge we have shown for the first time in a prospec tive controlled study that febrile infectious episodes correlate with poor long-term renal graft function.