Intestinal Colonization Resistance and the Cytokine Response Associated with Hyperoxaluria in the Patients with Recurrent Pyelonephritis

Abstract

Natalia Stepanova, Victoria Driianska, Natalia Stashevska, Georgy Drannik and Mykola Kolesnyk

Introduction and Aims: Hyperoxaluria and the violation of intestinal colonization resistance can be trigger factors in the formation of recurrent pyelonephritis. The aim of our study was to investigate the intestinal colonization resistance and the serum cytokines concentration in the patients with recurrent pyelonephritis depending on the presence of hyperoxaluria.

Materials and Methods: The observational cross-sectional study involved 70 women with recurrent pyelonephritis caused by E. coli or S. faecalis, non-stone formers. The state of the patients’ intestinal colonization resistance was evaluated by bacteriological study of feces, determination of secretory IgA (sIg A) and IgA against lipopolysaccharide (LPS) of gramnegative bacteria in saliva and levels of interleukins (IL) -4 - 17, -23 and monocytic chemotactic protein-1 (MCP-1) in the serum. According to the presence of hyperoxaluria, the women were allocated into two groups: the first group of the patients (n = 38) had hyperoxaluria (> 44mg in 24 hours) and the second one (n = 32) didn’t have any hyperoxaluria. The samples of faces had been collecting during the presence of clinical symptoms of pyelonephritis before starting the antibiotic therapy. The cytokines concentrations were analyzed using ELISA and STAT FAX-303 PLUS (Diaclon, France; DRG, Germany; Ukrmedservice, Ukraine). All the statistical analyses were performed using MedCalc.

Results: Microbiological studies of the colon microflora showed a lower content of Lactobacillus spp. in 53/70 (76%) in the patients with recurrent pyelonephritis. The blood levels of IL-4, IL-17, IL-23 and MCP-1 in the women with hyperoxaluria were significantly higher compared with the non-hyperoxaluria patients: 62.2 [52.8-74.1] vs 44.5 [35.8-67] pg/ml (P=0.019), and 130.7 [101.3-231.2] vs 103.4 [77.5-133.9] (P=0.03), 123.2±17.1 vs 80.98±29.4 (P=0.03) and 325.2 [211-500] vs 121.4 [104-107.8] (P=0.0003), respectively. The saliva levels of sIg A and IgA against LPS were significantly higher in patients of the first group: 298 ± 104 vs 150.1 ± 79.3 (P<0.0001) and 0.353 ± 0.16 vs 0,211 ± 0.09 respectively. In addition, we identified a moderate direct correlation between the blood level of IL-17 in the patients with recurrent pyelonephritis and daily excretion of oxalate: R=0.54, P=0.03.

Conclusions: The deficit of Lactobacillus spp. violates the immune response and oxalate metabolism with formation of hyperoxaluria. The blood cytokines concentration in the patients with recurrent pyelonephritis and hyperoxaluria has not been scrutinized before. The further studies are needed to determine the role of these cytokines in the progression of urolithiasis in hyperoxaluric conditions

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