Clinical Department No 3, Internal Medicine and Nephrology, "Carol Davila" University of Medicine and Pharmacy, 050474 Bucharest, Romania.
"Dr. Carol Davila" Teaching Hospital of Nephrology, Nephrology Department, Cal. Grivitei No 4, Sector 1, 010731 Bucharest, Romania.
Medicina (Kaunas). 2022 Dec 27;59(1):49. doi: 10.3390/medicina59010049.
Chronic kidney disease (CKD) has been a constant burden worldwide, with a prevalence of more than 10% of the population and with mortality reaching 1.2 million deaths and 35.8 million disability-adjusted life years (DALYs) in 2017, as it is claimed by the Global Burden of Diseases. Moreover, an increase in its prevalence is expected in the next years due to a rise in the number of people suffering from obesity, diabetes mellitus and hypertension. On the other hand, with cardiovascular morbidity and mortality showing a downward trend, maybe it is time to focus on CKD, to minimize the preventable risk factors involved in its progression toward end-stage kidney disease (ESKD) and to offer a better quality of life. Another major health burden is represented by infectious diseases, particularly urinary tract infections (UTIs), as it is considered that approximately 40-50% of women and 5% of men will have at least one episode during their lifetime. Additionally, CKD consists of a constellation of immunological and metabolical disturbances that lead to a greater risk of UTIs: increased apoptosis of lymphocytes, elevated levels of tumor necrosis factor α and interleukin 6, which lower the function of neutrophils and increased levels of uremic toxins like p-cresyl sulfate and indoxyl sulfate, which alter the adherence and migration of leukocytes to the sites of injury. Moreover, UTIs can lead to a more rapid decline of kidney function, especially in stages G3-G5 of CKD, with all the complications involved. Last, but not least, antibiotherapy is often complicated in this category of patients, as antibiotics can also negatively affect the kidneys. This review will try to focus on the particularities of the urinary microbiome, asymptomatic bacteriuria and UTIs and the subtle balance between the risks of them and the risks of antibiotherapy in the evolution of CKD.
慢性肾脏病（CKD）一直是全球的一个沉重负担，全球患病率超过 10%，据全球疾病负担研究称，2017 年的死亡率达到 120 万人，伤残调整生命年（DALYs）为 3580 万。此外，由于肥胖、糖尿病和高血压患者人数的增加，预计未来几年其患病率还会上升。另一方面，心血管发病率和死亡率呈下降趋势，也许现在是时候关注 CKD 了，最大限度地减少其进展为终末期肾病（ESKD）的可预防危险因素，提高生活质量。另一个主要的健康负担是传染病，特别是尿路感染（UTI），因为大约 40-50%的女性和 5%的男性在其一生中至少会发生一次。此外，CKD 还包括一系列免疫和代谢紊乱，导致 UTI 的风险增加：淋巴细胞凋亡增加，肿瘤坏死因子 α 和白细胞介素 6 水平升高，降低中性粒细胞的功能，以及尿毒症毒素如对甲酚硫酸和吲哚硫酸水平升高，改变白细胞对损伤部位的黏附和迁移。此外，UTI 可导致肾功能更快下降，尤其是在 CKD 的 G3-G5 期，涉及所有相关并发症。最后但同样重要的是，抗生素治疗在这类患者中经常变得复杂，因为抗生素也会对肾脏产生负面影响。这篇综述将试图重点关注尿液微生物组、无症状菌尿和 UTI 的特殊性，以及在 CKD 进展过程中它们的风险与抗生素治疗风险之间的微妙平衡。
