Pyuria, urinary tract infection and renal outcome in patients with chronic kidney disease stage 3-5

• Published in: Scientific reports Vol. 10; no. 1; p. 19460
• Main Authors: Kuo, I-Ching, Lee, Jia-Jung, Hwang, Daw-Yang, Lim, Lee-Moay, Lin, Hugo You-Hsien, Hwang, Shang-Jyh, Chen, Hung-Chun, Hung, Chi-Chih
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 10.11.2020; Nature Publishing Group UK
• Subjects: Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Chronic infection; Diabetes mellitus; End-stage renal disease; Epidermal growth factor receptors; Female; Glomerular Filtration Rate - drug effects; Glomerular Filtration Rate - physiology; Humans; Kidney - drug effects; Kidney - pathology; Kidney - physiopathology; Kidney diseases; Male; Middle Aged; Outcome Assessment, Health Care - methods; Outcome Assessment, Health Care - statistics & numerical data; Proportional Hazards Models; Pyuria; Pyuria - complications; Pyuria - physiopathology; Renal function; Renal Insufficiency, Chronic - complications; Renal Insufficiency, Chronic - drug therapy; Renal Insufficiency, Chronic - physiopathology; Urinary tract; Urinary tract diseases; Urinary tract infections; Urinary Tract Infections - complications; Urinary Tract Infections - physiopathology; Urogenital system
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-020-76520-5

Pyuria is common in chronic kidney disease (CKD), which could be due to either urinary tract infection (UTI) or renal parenchymal inflammation. Only little is known regarding the association of pyuria or UTI with renal outcomes. We investigated 3226 patients with stage 3-5 CKD. Pyuria was defined as ≥ 50 WBC per high-power field (hpf) and was correlated to old age, female, diabetes, hypoalbuminemia, lower eGFR, and higher inflammation status. In Cox regression, patients with more than one episode of pyuria in the first year (11.8%) had increased risks for end-stage renal disease (ESRD) [hazard ratio (95% CI): 1.90 (1.58-2.28); p < 0.001], rapid renal function progression [odds ratio (95% CI): 1.49 (1.13-1.95); p = 0.001], and all-cause mortality [hazard ratio: 1.63 (1.29-2.05); p < 0.001], compared to those without pyuria. In a subgroup analysis, the risk of pyuria for ESRD was modified by CKD stages. We investigated the effects of UTI (urinary symptoms and treated by antibiotics) and pyuria without UTI (urine WBC < 50 to ≥ 10/hpf without any episodes of ≥ 50 WBC/hpf or UTI), while both groups were associated with clinical outcomes. In conclusion, CKD stage 3-5 patients with frequent pyuria or UTI episodes have increased risks of renal outcomes.