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Bacterial attachment, inflammation and renal scarring in urinary tract infection
1Department of Clinical Immunology, University of Göteborg, Sweden.
Insights
Certain E. coli strains bind to a specific receptor, increasing inflammation and risk of kidney scarring in children with urinary tract infections (UTI). This binding capacity predicts scarring risk.
Area of Science:
- Microbiology
- Pediatrics
- Nephrology
Background:
- Escherichia coli (E. coli) causes over 90% of childhood urinary tract infections (UTIs).
- Adherence to urinary tract epithelial cells is a key virulence factor for uropathogenic E. coli, particularly in acute pyelonephritis.
- The Galactose alpha 1-4Galactose beta (Gal alpha 1-4Gal beta) disaccharide is identified as the minimal receptor for adherence of uropathogenic E. coli.
Purpose of the Study:
- To investigate the association between E. coli strains expressing the Gal alpha 1-4Gal beta binding specificity and the severity of acute pyelonephritis.
- To determine if Gal alpha 1-4Gal beta binding influences the development of renal scarring in children following UTI.
Main Methods:
- A cohort of children with UTIs was assessed for E. coli binding capacity to the Gal alpha 1-4Gal beta receptor.
- Clinical parameters including body temperature, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), pyuria, and renal concentrating capacity were measured.
- Renal scarring was evaluated in relation to E. coli binding specificity using a newly developed latex agglutination assay.
Main Results:
- E. coli strains with Gal alpha 1-4Gal beta binding specificity were associated with significantly higher body temperature, CRP, ESR, and pyuria.
- These binding bacteria also led to a lower renal concentrating capacity compared to E. coli lacking this specificity.
- The frequency of renal scarring was markedly higher (40%) in boys infected with Gal alpha 1-4Gal beta-negative E. coli compared to those with Gal alpha 1-4Gal beta-positive E. coli (5%).
Conclusions:
- E. coli strains that bind to the Gal alpha 1-4Gal beta receptor are potent inducers of acute inflammation during childhood UTIs.
- The presence of Gal alpha 1-4Gal beta binding specificity in E. coli is a significant protective factor against renal scarring.
- The latex agglutination assay for detecting Gal alpha 1-4Gal beta binding capacity serves as an effective predictor for the risk of renal scarring in pediatric UTI.
Abstract:
E. coli cause greater than 90% of urinary tract infections (UTI) in childhood. The capacity to adhere to urinary tract epithelial cells characterizes E. coli strains that cause acute pyelonephritis. Galactose alpha 1-4Galactose beta is the minimal receptor for adhering uropathogenic E. coli. Gal alpha 1-4Gal beta-binding bacteria caused significantly higher body temperature, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), pyuria, and lower renal concentrating capacity than E. coli lacking this specificity. The binding bacteria thus appeared to be more potent inducers of acute inflammation. Since inflammation may lead to tissue damage, we examined the relationship of infection with Gal alpha 1-4Gal beta-positive bacteria to renal scarring. The frequency of renal scarring was 5% in boys with Gal alpha 1-4Gal beta-positive and 40% in boys with Gal alpha 1-4Gal beta-negative E. coli. Analysis of binding capacity with the help of a newly developed latex agglutination assay can thus be used as an effective predictor of risk for renal scarring.