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Quantitation of urinary Tamm-Horsfall protein in children with urinary tract infection
H H Reinhart1, J R Spencer, N F Zaki
1Division of Infectious Diseases, Wayne State University, Detroit, Mich.
Insights
Urinary Tamm-Horsfall protein (THP) may protect against urinary tract infections (UTIs). In children with recurrent UTIs, aggregated THP levels were lower during infection, suggesting a role in UTI development.
Area of Science:
- Urology
- Microbiology
- Pediatrics
Background:
- Urinary Tamm-Horsfall protein (THP) is hypothesized to prevent urinary tract colonization by uropathogens.
- Recurrent urinary tract infections (UTIs) in children represent a significant clinical challenge.
- Understanding the role of urinary biomarkers in UTI pathogenesis is crucial for developing targeted interventions.
Purpose of the Study:
- To investigate the hypothesis that low urinary THP levels predispose children to urinary tract infections (UTIs).
- To compare THP levels in children with recurrent UTIs, those with myelomeningocele undergoing catheterization, and healthy controls.
- To analyze the relationship between aggregated (aTHP) and disaggregated (dTHP) forms of THP and UTI status.
Main Methods:
- A cohort study involving 35 girls with recurrent UTIs, 27 patients with myelomeningocele, and 16 female controls.
- Measurement of urinary THP in both aggregated (aTHP) and disaggregated (dTHP) forms.
- Assessment of leukocyte esterase activity, urine chemistries, and urine culture to determine infection status.
Main Results:
- No significant difference in dTHP or aTHP levels between children with recurrent UTIs and controls.
- Children with recurrent UTIs had higher dTHP levels compared to those with myelomeningocele.
- Markedly lower aTHP levels were observed in children with pyuria or bacteriuria compared to those with sterile urine samples.
Conclusions:
- Urinary dTHP excretion is not reduced in children with a history of recurrent UTIs.
- Concentrations of aggregated THP (aTHP) are significantly depressed during active UTIs in children.
- Aggregated THP levels may play a role in the pathogenesis of UTIs and warrant further investigation for diagnostic and therapeutic potential.
Abstract:
It has been suggested that urinary Tamm-Horsfall protein (THP) prevents colonization of the urinary tract by binding uropathogens. We tested the hypothesis that low urinary THP levels may predispose to urinary tract infection (UTI) by measuring THP levels in children. We studied a cohort of 35 girls with uncomplicated recurrent UTI (group 1) that was compared with 27 patients with myelomeningoceles undergoing clean intermittent catheterization (group 2) and 16 female controls (group 3). We measured urinary THP in both aggregated (aTHP) and disaggregated form (dTHP), leukocyte esterase activity, urine chemistries and culture. No significant differences in dTHP or aTHP levels were seen between groups 1 and 3, but group-1 patients had higher dTHP levels than group-2 patients (p < 0.008). History of reflux or the presence of bacteriuria or pyuria at the time of urine collection did not affect dTHP levels; in contrast, pyuria or bacteriuria at the time of sampling was associated with markedly lower aTHP levels when compared with sterile samples (p < 0.0001). For all groups, measured quantities of dTHP did not correlate with aTHP levels. We conclude that excretion of dTHP in children with history of recurrent UTI is not reduced. In contrast, concentrations of aTHP are profoundly depressed in children during times of UTI, suggesting a role for THP in the pathogenesis of UTI. Assaying THP in its aggregated form may prove valuable when studying its physiologic function and merits further investigation.