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[Defense mechanisms of the macro-organism in bacteriuria in chronic pyelonephritis]
Abstract:
In the course of 4 years we isolated 193 E. coli strains of 55 patients with chronic pyelonephritis. In patients with obstructive chronic pyelonephritis the mean value of the immunofluorescence titre (in the serum) to the E. coli strain excreted in the urine as well as the total complement were significantly increased, the serum lysozyme was significantly lower than in patients with non-obstructive chronic pyelonephritis. A relation to the activity of the disease was existing only in the non-obstructive chronic pyelonephritis, where in the active stage the total complement was significantly decreased, the complement factors C3 and C4 as well as the urine lysozyme were significantly increased in comparison to the inactive stage. 94.64% of all immunofluorescence titres obtained to the homologous strain in the patients' serum were above the border of the normal area of 1:40. A relation between level of the titre and activity of the disease could not be established. No significant differences could be proved between the titres taken to serum-sensitive and serum-resistant strains. In 32.73% of the patients we observed disturbances of the serum bactericidia against the homologous serum-sensitive E. coli urine strain at one or several points. They fall to equal shares to patients with obstructive and non-obstructive chronic pyelonephritis and were found at 66.67% in the active stage of the two forms of the disease. In patients with and without disturbances of bactericidia no significant differences in the total complement, in the complement factors C3 and C4, the C3-activator, the serum lysozyme and the immunofluorescence titres could be proved.
Insights
This study found distinct immune responses in obstructive versus non-obstructive chronic pyelonephritis patients. Obstructive cases showed higher antibody titers and complement levels, while non-obstructive cases had altered complement and lysozyme during active disease stages.
Area of Science:
- Nephrology
- Immunology
- Microbiology
Background:
- Chronic pyelonephritis is a persistent kidney infection often caused by Escherichia coli (E. coli).
- Understanding the host immune response is crucial for managing this condition, particularly differentiating between obstructive and non-obstructive forms.
- Immune markers like complement, lysozyme, and antibody titers may provide insights into disease activity and patient outcomes.
Purpose of the Study:
- To investigate and compare the immunological profiles of patients with obstructive and non-obstructive chronic pyelonephritis.
- To assess the relationship between immune markers and disease activity in different forms of chronic pyelonephritis.
- To evaluate the prevalence of serum bactericidal defects against homologous E. coli strains.
Main Methods:
- Prospective study over 4 years involving 55 patients with chronic pyelonephritis.
- Isolation and characterization of 193 E. coli strains from urine samples.
- Measurement of serum and urine immunofluorescence titers, total complement, complement factors (C3, C4), serum and urine lysozyme, and serum bactericidal activity against homologous E. coli strains.
Main Results:
- Patients with obstructive chronic pyelonephritis exhibited significantly higher serum immunofluorescence titers and total complement levels, and lower serum lysozyme compared to non-obstructive cases.
- In non-obstructive pyelonephritis, active disease stages showed significantly decreased total complement and increased complement factors (C3, C4) and urine lysozyme compared to inactive stages.
- Serum bactericidal defects against homologous E. coli were observed in 32.73% of patients, occurring equally in both obstructive and non-obstructive forms and more frequently in active disease stages.
Conclusions:
- Distinct immunological differences exist between obstructive and non-obstructive chronic pyelonephritis, suggesting different host-pathogen interactions.
- Immune marker fluctuations correlate with disease activity specifically in non-obstructive chronic pyelonephritis.
- Impaired serum bactericidal activity is a notable finding in a subset of patients, irrespective of disease obstruction status.