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Urinary ATP and bacteria in shed urothelial cells as a superior diagnostic marker for urinary tract infection in renal transplant recipients
Author(s) -
Kelley Stephen Patrick,
Birch Rebecca,
ScottWard Toby S,
PeppiattWildman Claire. M,
Farmer Chris,
Delaney Michael,
Wildman Scott S.P
Publication year - 2013
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.27.1_supplement.646.9
Subject(s) - urinary system , urinalysis , microbiological culture , renal transplant , medicine , bacteria , urology , urine , gastroenterology , transplantation , biology , genetics
Urinary tract infections (UTIs) cause complications for renal transplant recipients (RTRs) and may result in graft loss. Routine urinalysis to detect UTIs is insensitive/inaccurate in RTRs. UTI detection methods with greater accuracy are needed. A ≥50 nmol/l urinary ATP concentration indicates UTI and ATP measurement may be a superior diagnostic test (1). We investigated various urinalysis tests in 53 RTRs. ATP concentrations and intracellular bacteria (IB) in shed urothelial cells were compared to bacterial culture results. 22% of RTRs tested UTI positive by bacterial culture. IB were identified in 44% or RTRs, but only 2% IB positive were also UTI positive by bacterial culture. There was a significant association of the conventional bacterial culture with both urinary ATP concentration and evidence of IB (Fisher's exact test, p <0.05). 6% of RTRs had ATP concentrations ≥50 nmol/l. Those positive were also bacteria positive. 77% patients with ATP concentrations <50 nmol/l were negative by bacteria culture. Diagnostic odds ratios (DORs) indicated that ATP was a much stronger UTI indicator (DOR = 30.580) compared to IB (0.079). However combined urinary ATP concentration and evidence of IB was an even stronger diagnostic indicator of UTI (DOR = 105). Low urinary ATP concentration combined with absence of IB in shed urothelial may provide as superior diagnostic test for absence of UTI in RTRs. Funding: St Peter's Trust (UK).