Abstract
Introduction
Children with recurrent urinary tract infections (rUTI) often show no identifiable cause of their infections. Neutrophil gelatinase-associated lipocalin (NGAL) is known to be upregulated within the uroepithelium and kidney of patients with UTI and exhibits a localized bacteriostatic effect through iron chelation. We hypothesize that some patients with rUTI without an identifiable cause of their recurrent infections have locally deficient NGAL production. We therefore explored whether a lack of NGAL production may be a factor in the pathogenesis of rUTI.
Materials and methods
Patients seen in the urology clinic for rUTI who were <21 years of age were enrolled. Patients were excluded if they had UTI at the time of enrollment, evidence of renal disease, decreased renal function, known anatomic abnormality of the genitourinary tract, or other reasons that predispose to UTI, such as neurogenic bladder, the need for intermittent catheterization, or unrepaired posterior urethral valves. Control patients were healthy children enrolled from the emergency department with no history of UTI or renal dysfunction, normal urinalysis at the time of enrollment, and presenting no diagnosis associated with increased NGAL levels, such as acute kidney injury or infection. NGAL was measured by immunoblot.
Results
Fifteen cases and controls were enrolled. Median urinary NGAL levels were significantly decreased in rUTI patients compared with controls [15 (14–29) ng/ml vs 30 (27–61) ng/ml; p = 0.002)] Although comparatively diminished, measurable NGAL levels were present in all patients with rUTI.
Conclusions
Urinary NGAL is significantly decreased in patients with compared with patients without rUTI. These data suggest that some patients with rUTI may be predisposed to UTI because of a relative local deficiency in urinary NGAL production.
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Acknowledgements
This work was supported by the Frederick Lovejoy Resident Research Fund (Forster), The Society of Pediatric Urology Research Award (Lee), R01 DK096238 (Lee), and R01 DK073462 (Barasch).
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Dr. Jonathan Barasch has a financial relationship with Abbot and Alere, whereby Columbia University has a standard licensing agreement with Abbot and Alere enacted over 10 years ago. Dr. Barasch does not have any direct or indirect commercial incentive associated with publishing this work. The remaining authors have nothing to declare.
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Richard Bachur and Richard S. Lee contributed equally to this work.
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Forster, C.S., Johnson, K., Patel, V. et al. Urinary NGAL deficiency in recurrent urinary tract infections. Pediatr Nephrol 32, 1077–1080 (2017). https://doi.org/10.1007/s00467-017-3607-6
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DOI: https://doi.org/10.1007/s00467-017-3607-6