A pilot study on immune expression in children with vesicoureteral reflux

Author info »

Description

Vesico Ureteral Reflux (VUR) is a common pediatric urological condition characterized by the abnormal flow of urine from the bladder into the ureters and sometimes into the kidneys. It is associated with recurrent Urinary Tract Infections (UTIs) and may lead to renal damage if left untreated. While the pathophysiology of VUR is multifactorial, the role of the immune system in its development and progression remains an area of ongoing research. Vesico Ureteral Reflux (VUR) is a urinary tract condition primarily affecting children, where urine flows backward from the bladder into the ureters and potentially up into the kidneys. This condition can lead to Urinary Tract Infections (UTIs) and, in severe cases, kidney damage. Understanding the immune expression in children with VUR is crucial in comprehending the disease’s pathogenesis and guiding treatment strategies.

The immune system plays a critical role in defending the body against infections, and its involvement in VUR is multifaceted. Immune expression in children with VUR can be analyzed at different levels. Innate immune responses are the body’s initial defense against pathogens. In children with VUR, abnormalities in the urinary tract can impair this defense. For example, structural anomalies may obstruct the normal flow of urine, producing stagnant pockets where bacteria can survive. This can lead to recurrent UTIs, prompting immune responses such as inflammation.

Adaptive immunity involves specialized immune cells, such as T and B lymphocytes, which develop memory to recognize specific pathogens. In VUR, frequent UTIs can stimulate the adaptive immune system, leading to an increased production of antibodies against common pathogens. Over time, this heightened immune response may contribute to kidney damage if left untreated. UTIs triggered by VUR can result in inflammation of the urinary tract and kidneys. Immune cells, such as neutrophils and macrophages, are recruited to combat the infection. However, chronic inflammation can damage kidney tissues, affecting their function and possibly leading to scarring.

Some children may have genetic predispositions that make them more susceptible to VUR. These genetic factors can influence immune expression, impacting how the body responds to UTIs and the degree of inflammation and damage that may occur. The gut and urinary microbiota play a role in immune regulation. Alterations in these microbial communities may affect immune responses in children with VUR. Research into the microbiome’s role in VUR is ongoing and may provide insights into the condition’s pathogenesis. In some cases, children with severe VUR may be prescribed immunosuppressive medications to reduce inflammation and prevent kidney damage. These drugs can modulate immune expression to protect the kidneys, but they also carry potential risks, such as increased susceptibility to other infections.

Specific urinary biomarkers associated with inflammation, such as C – Reactive Protein (CRP) and Neutrophil Gelatinase-Associated Lipocalin (NGAL), were significantly higher in the VUR group. The findings of this pilot study suggest a prominent role of the immune system in children with vesicoureteral reflux. Elevated proinflammatory cytokines, increased immune cell activation, and altered immune cell populations indicate an ongoing immune response in VUR patients, possibly triggered by repeated UTIs.

The increase in proinflammatory cytokines such as IL-6, IL-8, and TNF-α suggests chronic inflammation within the urinary tract, which may contribute to the pathogenesis and progression of VUR. The decreased levels of anti-inflammatory cytokine IL-10 further indicate an imbalance toward proinflammatory responses in these patients.

Conclusion