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Why are diabetics prone to kidney infections?
Michael Zasloff
Michael Zasloff
Published November 12, 2018
Citation Information: J Clin Invest. 2018;128(12):5213-5215. https://doi.org/10.1172/JCI124922.
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Commentary

Why are diabetics prone to kidney infections?

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Abstract

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.

Authors

Michael Zasloff

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Figure 1

Increased incidence of UTI in diabetics.

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Increased incidence of UTI in diabetics.
In the healthy urinary tract, t...
In the healthy urinary tract, the epithelium of the urethra, bladder, ureters, and the collecting ducts express and secrete a cocktail of antimicrobial peptides and proteins (AMPs) that effectively constrain fecal uropathogenic E. coli (UPEC) bacteria from ascending into the parenchyma of the kidney. The expression of several of these AMPs, produced by the ICs of the collecting ducts, is dependent on the classical insulin signaling pathway (red arrows). In the direction of the urine flow down the collecting ducts (black arrow), the concentration of the antimicrobial cocktail increases, creating an increasingly more effective immune barrier. In the setting of 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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ISSN: 0021-9738 (print), 1558-8238 (online)

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