Home 2 Forums Diabetes Mellitus Why are diabetics prone to kidney infections?

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    Sunil Kumar

    The Journal of Clinical Investigation reported People with diabetes mellitus are at higher risk of developing serious ascending infections of the urinary tract. The traditional explanation has focused on the role of glycosuria in promoting bacterial growth.

    Using mouse models, Murtha et al. demonstrate that when the intracellular insulin signaling pathway is compromised, antimicrobial defenses are compromised too, and the mice are unable to effectively handle uropathogenic E. coli introduced experimentally into the urinary tract. These observations strongly support the hypothesis that the antimicrobial defenses of the kidney are dependent on insulin, and the urinary tract infections associated with diabetes occur due to reduced expression of these key effectors of innate immunity.

    Uropathogenic E. coli (UPEC) is the cause of 80% of UTI. The infection usually begins as a cystitis. UPEC binds to the bladder epithelium, invades the superficial cells, and forms intracellular bacterial communities (11). If the infection is not controlled at this stage, the microbes ascend into the collecting tubules, provoking an intense inflammatory response, recognized clinically as pyelonephritis.

    Type 2 diabetes, which is characterized by insulin resistance, expression of the insulin-dependent AMPs is suppressed, creating a less optimal antimicrobial environment, permitting viable microbes to ascend into the collecting ducts. Once attached to the epithelium of the collecting ducts, bacteria invade the epithelial cells, expand in number, and subsequently provoke an acute inflammatory response, clinically recognized as pyelonephritis.

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