Antibiotic Management of Urinary Tract Infection in the Chronic Renal Failure Patient

Abstract

Preservation of renal function in patients with established renal failure is an important goal in overall management, even in patients who require maintenance dialysis. Although hypertension and obstruction have been identified as reversible causes of deterioration in renal function, urinary tract infection has received little attention. In patients undergoing renal transplantation, the native kidneys might serve as a source of sepsis for the immunosuppressed recipient. In addition, bacterial antigens in the renal parenchyma could trigger rejection episodes. These theoretic possibilities have led to pretrans-plant bilateral nephrectomy in patients known to have active or remote urinary tract infection. Therapy of such patients with antibiotics has not been examined critically especially in the context of recent knowledge concerning the renal handling of antibiotics in patients with normal and impaired renal function.