HYPEROXALURIA AND BIOMARKERS OF MUCOSAL IMMUNITY IN PATIENTS WITH RECURRENT PYELONEPHRITIS

Abstract

Summary: The aim of our study was to compare the performance of mucosal immunity in urine and saliva of patients with chronic recurrent pyelonephritis subject to availability of hyperoxaluria. Material and methods. To observational cross–sectional study included 40 women with chronic recurrent pyelonephritis, aged 21 to 48 years (31.6±7.7). Depending on the availability hyperoxaluria (oxalate excretion in the urine than 0.45 mmol per day) patients were divided into II Groups: for I (n=29) included women with hyperoxaluria, to II (n=11) – includes patients with normal excretion oxalate (7.2±2.4 vs 43.8±5.2; p <0.001). State of mucosal immunity was assessed by determining the content of lysozyme, lactoferrin, secretory immunoglobulin A (sIg A) and tumor necrosis factor alpha (TNF– a) in urine samples and content sIg A and class antibodies sIg A to lipopolysaccharide (LPS) of gram–negative bacteria (anti–LPS–sIgA) in saliva. Results. We have identified significantly higher levels of sIg A and anti–LPS–sIgA in the saliva ofpatients with recurrent pyelonephritis with hyperoxaluria (298±104 vs 150.1±79.3 mg/1, p<0.001) and (0.353±0.16 vs 0.211±0.09, p<0.001), respectively. In the urine ofwomen of group I we havefound a statistically significant increase in the content of TNF– a 44 [16.2–130.5] vs 21 [14.2–3.45] pg/ml (p=0.04) and lysozyme 14.0[2.5– 36.5]vs 1.45[0.12–7.5]ng/ml (p=0.002). All the studied parameters (anti–LPS–sIg A in saliva and sIg A, lactofer– rin and lysozyme urine) had a direct correlation with the level of daily oxalate excretion. Conclusions. Overproduction of indicators of mucosal immunity may be explained by the formation of intestinal dysbiosis under the influence of continuous antibiotic therapy. The imbalance of intestinal microflora, in turn, leads to the formation of hyperoxaluria and increases the production of antibodies to LPS, sIg A, lactoferrin and lysozyme.

Keywords

• recurrent pyelonephritis, mucosal immunity, hyperoxaluria, lysozyme, lactoferrin, secretory immunoglobulin A.