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Local immune response to upper urinary tract infections in children

Anu Kantele1, Nina Palkola, Heikki Arvilommi

  • 1Division of Infectious Diseases, Department of Medicine, Helsinki University Central Hospital, PL 348, FIN-00029 HUS Helsinki, Finland. anu.kantele@hus.fi

Clinical and Vaccine Immunology : CVI
|January 11, 2008
PubMed

Insights

Urinary tract infection (UTI) in children triggers a circulating antibody-secreting cell (ASC) response that increases with age. This suggests systemic immunity is key in pediatric UTI defense, aiding in preventing recurrence.

Area of Science:

  • Immunology
  • Pediatrics
  • Infectious Diseases

Background:

  • Urinary tract infections (UTIs) in children, particularly pyelonephritis (PN), can lead to renal scarring, necessitating effective vaccines.
  • Local immune mechanisms are crucial for protection against UTIs but are poorly understood in pediatric populations.
  • Understanding the immune response in children is vital for developing targeted preventative strategies against recurrent UTIs.

Purpose of the Study:

  • To investigate the local immune response in children experiencing UTIs by detecting pathogen-specific antibody-secreting cells (ASCs).
  • To characterize the kinetics and type (IgM vs. IgA) of ASC responses in children with PN.
  • To correlate ASC responses with clinical outcomes, including recidivism and renal scarring, over a 6-month follow-up.

Main Methods:

  • Studied 37 children diagnosed with PN, analyzing circulating pathogen-specific ASCs against their infecting agents or P fimbriae.
  • Quantified ASCs in peripheral blood mononuclear cells (PBMCs) and assessed the immunoglobulin type (IgM/IgA) of the response.
  • Monitored patients for 6 months to record UTI recidivism and identify renal scarring using imaging techniques.

Main Results:

  • Pathogen-specific ASCs were detected in 33 out of 37 children, with response magnitude increasing with age.
  • IgM dominance was observed in 18/33 cases, more frequent in infants (63%) than older children (30%), contrasting with adult IgA dominance.
  • The most robust ASC response was to whole Escherichia coli bacteria, followed by P fimbriae; responses peaked at 1-2 weeks post-symptom onset.

Conclusions:

  • Circulating ASC responses are present in children with UTIs, increasing in magnitude with age.
  • The significant IgM-dominated response in children suggests a greater reliance on systemic immune mechanisms compared to adults.
  • The low rate of recidivism (19%) indicates a potentially successful immune defense, highlighting the importance of understanding these responses for vaccine development.

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