Immunoglobulin in urine from ileal conduit and nephrostomy patients

Patients with ileal conduits frequently have bacteruria, and some have pyelonephritis with associated renal deterioration. We attempted to find a noninvasive technique that could be used to define the source of the bacteria in such patients. Neither the antibody-coated bacteria test nor the selective immunofluorescent antibody studies made this distinction. Quantitative immunoglobulin determinations performed on urine from ileal conduits containing either less or greater than 10(5) bacteria per ml showed IgA to be the predominant immunoglobulin. Urine from patients with permanent nephrostomy drainage who had known chronic upper urinary tract infection contained predominantly IgG. Inasmuch as several studies have shown that both normal urine and urine from patients with pyelonephritis contain more IgG than IgA, we conclude that the conduit added IgA to the urine. However, even this quantitative immunoglobulin technique is unable to identify the source of the bacteria. To do so would have required an invasive collection of upper tract urine. The occurrence of acute symptomatic pyelonephritis was rare during the 18 months of the study, but the urine of the one ileal conduit patient with acute pyelonephritis studied contained more IgG than IgA.