Colceriu Marius-Cosmin, Aldea Paul Luchian, Răchișan Andreea-Liana, Clichici Simona, Sevastre-Berghian Alexandra, Mocan Teodora
Department of Functional Biosciences, Discipline of Physiology, Iuliu Haţieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
Department of Community Medicine, Discipline of Public Health and Management, Iuliu Haţieganu University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania.
J Clin Med. 2023 Mar 19;12(6):2380. doi: 10.3390/jcm12062380.
Vesicoureteral reflux represents one of the most concerning topics in pediatric nephrology due to its frequency, clinical expression with the potential to evolve into chronic kidney disease, and last but not least, its socio-economic implications. The presence of vesicoureteral reflux, the occurrence of urinary tract infections, and the development of reflux nephropathy, hypertension, chronic kidney disease, and finally, end-stage renal disease represent a progressive spectrum of a single physiopathological condition. For the proper management of these patients with the best clinical outcomes, and in an attempt to prevent the spread of uropathogens' resistance to antibacterial therapy, we must better understand the physiopathology of urinary tract infections in patients with vesicoureteral reflux, and at the same time, we should acknowledge the implication and response of the innate immune system in this progressive pathological condition. The present paper focuses on theoretical aspects regarding the physiopathology of vesicoureteral reflux and the interconditionality between urinary tract infections and the innate immune system. In addition, we detailed aspects regarding cytokines, interleukins, antimicrobial peptides, and proteins involved in the innate immune response as well as their implications in the physiopathology of reflux nephropathy. New directions of study should focus on using these innate immune system effectors as diagnostic and therapeutic tools in renal pathology.
由于膀胱输尿管反流的发生率、可能发展为慢性肾脏病的临床表现，以及最后但同样重要的社会经济影响，它是小儿肾脏病学中最受关注的话题之一。膀胱输尿管反流的存在、尿路感染的发生以及反流性肾病、高血压、慢性肾脏病，最终发展为终末期肾病，代表了单一病理生理状况的渐进过程。为了以最佳临床结果妥善管理这些患者，并试图防止尿路病原体对抗菌治疗产生耐药性，我们必须更好地了解膀胱输尿管反流患者尿路感染的病理生理学，同时，我们应该认识到先天免疫系统在这种进行性病理状况中的作用和反应。本文重点关注膀胱输尿管反流病理生理学的理论方面，以及尿路感染与先天免疫系统之间的相互关系。此外，我们详细阐述了参与先天免疫反应的细胞因子、白细胞介素、抗菌肽和蛋白质的相关方面，以及它们在反流性肾病病理生理学中的作用。新的研究方向应聚焦于将这些先天免疫系统效应物用作肾脏病理学的诊断和治疗工具。
