Beyond Infection: How Antimicrobial Therapies Influence the Urinary Microbiome and Stone Disease

Area of Science:

• Urology
• Microbiology
• Nephrology

Background:

• The urinary microbiome's role in urolithiasis (kidney stone disease) is increasingly recognized, extending beyond traditional metabolic and dietary causes.
• Specific uropathogens like Proteus mirabilis, Klebsiella pneumoniae, and Escherichia coli contribute to stone formation through various mechanisms.

Purpose of the Study:

• To review the mechanisms by which the urinary microbiome contributes to kidney stone formation.
• To critically examine the impact of antibiotic therapies on the urinary microbiome and stone risk.
• To explore emerging microbiome-targeted strategies for preventing and managing urolithiasis.

Main Methods:

• Literature review of studies investigating the urinary microbiome and urolithiasis.
• Analysis of mechanisms of stone formation involving specific bacterial species.
• Evaluation of the effects of antibiotic treatment on urinary tract microbial communities.
• Exploration of novel therapeutic approaches targeting the microbiome.

Main Results:

• Uropathogens facilitate stone formation via urease activity, citrate degradation, urine alkalinization, biofilm formation, and inflammation.
• Antibiotic use, especially recurrent or broad-spectrum, disrupts microbial homeostasis, depletes beneficial bacteria (e.g., Lactobacillus), and promotes colonization by stone-forming strains.
• Antibiotic-induced dysbiosis is linked to persistent imbalances and a higher risk of kidney stone recurrence.

Conclusions:

• The urinary microbiome is a significant factor in kidney stone etiology and recurrence.
• Antibiotic therapies can inadvertently increase stone risk by altering the urinary microbiome.
• Microbiome-targeted interventions like probiotics, prebiotics, and bacteriotherapy represent promising avenues for personalized prevention and management of kidney stone disease.