Q: I am a 45 years old woman who had a kidney transplant 11 years back. But 8 months back I suffered a rejection episode. It was an antibodies attack, which was treated successfully, since then I am anaemic and have recurrent UTI infection - Klebsiella pneumoniae and have been treated with different antibiotics orally and intravenously. The infection subsidies and rebounds every couple of days. Now I have been asked for a gynaecological evaluation to see the focus of infection if there is any recurrent pyuria? What is wrong with me?

A:Urinary tract infection happens to be the commonest bacterial infection in the immediate post transplant phase. However, it seems that you have been having recurrent UTIs much later following the episode of rejection early this year. This could be a result of either bladder disease (neurogenic bladder resulting in abnormal contraction of bladder muscles) or an anatomical abnormality in the urinary tract. These abnormalities can manifest at any time resulting in symptomatic UTIs compounded by life long intake of immunosuppressive drugs like steroids as in your case. I agree with further evaluation to study the bladder function called Urodynamic studies usually undertaken by an Urologist in consultation with your Gynaecologist. Meanwhile, I would recommend chronic prophylactic therapy with a low dose antibiotic to prevent recurrent UTI. Antibiotic of choice would be based upon most recent urine culture and sensitivity report. Commonly prescribed ones are Bactrim, Ciprofloxacin and Norfloxacin. Lastly, recurrent UTIs need to be managed on a timely manner since it can put you to risk for repeat rejection in months and years to follow.