Chronic Kidney Disease, Urinary Tract Infections and Antibiotic Nephrotoxicity: Are There Any Relationships?

Abstract

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.

Global, regional, and national burden of chronic kidney disease attributable to high fasting plasma glucose from 1990 to 2019: a systematic analysis from the global burden of disease study 2019

“…Additionally, healthcare infrastructure and the workforce should be strengthened worldwide to ensure adequate healthcare for patients with high blood pressure and high blood glucose and to reduce the risk of developing diabetic nephropathy. Moreover, urinary tract infections (UTIs), which are considered a major risk factor for CKD in childhood, although the etiology is not yet fully understood ( 28 ), have been shown to have a high prevalence worldwide, particularly among females ( 29 ). It is reported that approximately 40–50% of women will experience at least one episode of UTI during their lifetime ( 29 ).…”

“…Moreover, urinary tract infections (UTIs), which are considered a major risk factor for CKD in childhood, although the etiology is not yet fully understood ( 28 ), have been shown to have a high prevalence worldwide, particularly among females ( 29 ). It is reported that approximately 40–50% of women will experience at least one episode of UTI during their lifetime ( 29 ). Additionally, Micle et al.…”

Prevalence and Associated Factors of Urinary Tract Infection in Patients with Diabetic Neuropathy: A Hospital-Based Cross-Sectional Study

“…The possible reason is that patients with UTI use nephrotoxic antibiotics that can cause kidney damage. 22 In addition, patients with CKD have an increased risk of UTI, which may be related to immunodeficiency in patients with CKD. 23 However, no existing studies have reported the relationship of CKD and UTI in diabetic neuropathy patients.…”

Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies

“…These repeated infections may lead to persistent inflammation and damage to the transplanted kidney, resulting in a progressive decline in graft function. CKD is a serious long-term consequence of recurrent UTIs, highlighting the critical need to address and manage these infections effectively to protect the patient's renal health [ 72 ].…”