As  far as I  know asymptomatic bacteria should  be treated especially during  pregnancy  because   it can  lead to  many  adverse effects. So  it should  be treated regardless  with  one or two  kidneys 

No recommandations

The recommendations are based on underlying clinical and physiological reserve of a patient regardless of solitary or damaged kidneys. Even after renal transplant recommendations are vague and institutional protocol based. Solitary kidney/ solitary functional kidney or horseshoe kidney, all have similar recommendation for asymptomatic bacteriuira.

 http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Asymptomatic%20Bacteriuria.pdf

No treatmemt indicated.

There is no recommendation to treat Asyntomatic bacteriuria in solitary kidney. Since after Kidney transplant, there is no evidence that treatment could prevent pyelonephritis or has impact on graft survive. 

http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Asymptomatic%20Bacteriuria.pdf

Thank  you very much Erika Ferraz de Gouvêa   for your kind point

You should not use antibiotics to eradicate the bacteria. The amount of renal parenchyma is not important. The important thing is the ability to invasive bacteria

Yes no need to treat. Try non medical measures rather than antibiotics which will lead to resistance etc. Avoid constipation, increased fluid intake, probiotics, good glycaemic control etc. Keep them under surveillance only.

There is no recommendation to treat asymptomatic bacteriuria in solitary kidney. However, I know that it should be treated in pregnancy; therefore, 

The diagnosis of asymptomatic bacteriuria should be based on culture of a urine specimen collected in a manner that minimizes contamination . Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment.

 I think that the presence of a solitary kidney  don't change  the  classical indications to treat asintomatic bacteriuria. Instead I  think that the presence of  persistent  and  significant pyuria ,associated with other urine modifications typical of infection, may raccomand antimicrobical treatment.

In patients with single kidney and asymtomatic bactriuria not indicated to treated with antiobiotics.

Dear  Bijan Rezakhaniha  I think  we have to  treat asymtomatic bactriuria in  pregnant women

Warm  regards

Dear ishag adam of course but that question was about nonpregnant wemen.

No indication at all.

Best

Reinhold

No

Dear Bijan Rezakhaniha 

Deeply  sorry because of my background as obstetrician UTI  is night mare for us.  Therefore I   jumped to  the pregnancy 

In our usual practice, asymptomatic bacteriuria is not usually managed by antimicrobials especially in women. However, the situatiion is different with pregnancy where pregnant women with asymptomatic bacteriuria are at an increased risk for adverse outcomes, and these can be prevented with antimicrobial treatment of asymptomatic bacteriuria. Thus, pregnant women should be screened for bacteriuria and treated if test results are positive. On the other hand, treating asymptomatic bacteriuria in patients with diabetes, older persons, patients with indwelling catheters, or patients with spinal cord injuries has not been found to improve outcomes.

Dear  Mohamed A Elkoushy

Thank  you very much  for your comprehensive comments

I totally agree with Dr Mohamed Elkoushy and would like to add that recommendations for pregnant women are to be screened by urine culture by the end of first trimester. If asymptomatic bacteruria detected, then antibiotic is given and further screening during whole pregnancy is recommended. If no asymptomatic bacteruria is detected by screening at then end of first trimester, then no further screening is recommended during the whole course of pregnancy.

I totally  agree with  Ahmed Kotb

 No indication to treat  it if not pregnant.

it seems that  even  no  harm to  the non-pregnant women form  the asymptomatic organism

you have to do kidney functions tests first to know its conditon, you may ask for US scannig of the kidney as well before deciding to give antibiotic or not. Second is to know which organism is present and culuture sensitivity test to give the proper antibiotic if the kidney functions are reasonable.

Dear  Abdel Karim M. El Hemaly

I agree with  you but these  will  make the issue more expensive and needs more work-up

absolutely not

Dear  Paulo Dinis 

I mean more investigations and more treatments are needed if we have to  investigate  the asymptomatic  bacteriuria fully 

I know it will add extra money and more investigations, but it will save the kidney if it is comporomized.

I agree with  you Abdel Karim

Currently it is not indicated as there is no evidence of benefit. Of course the evidence can change, but I see no reason that this will happen in the case of  asymptomatic bacteriuria in patients non-pregnant with single kidney because the risk of upper urinary infection is extremely low. I personally have some doubts in patients with other risk factors (reflux, neurogenic bladder) or in patients with alteration in the smell of the urine (this are already symptomatic patients?)

Thanks Francisco Botelho  for comments

The current practice, in my neck of the woods, is to avoid antibiotic usage in asymptomatic patients. Unfortunately, the level of AROs (Antibiotic resistant organisms) has steadily increased related to the level of antibiotics given out prophylactically and usually without a culture and sensitivity. Given that the patient has a solitary kidney, I would be hesitant to administer an antibiotic to them. 

I like better to ask for " urine for culuture and sensitivity ]" test at first, then ask for kidney functions test, before proceeding futrher. If serum creatinine, and blood urea are within normal levels then I proceed according to the result of the "culture-sensitivity".

I agree with Abdel Karim M. El Hemaly