F344 rats chronically infected with Ureaplasma parvum develop two distinct profiles: asymptomatic urinary tract infection (UTI) and UTI complicated by struvite urolithiasis. To identify factors that affect disease outcome, we characterized the temporal host immune response during infection by histopathologic analysis and in situ localization of U. parvum. We also used differential quantitative proteomics to identify distinguishing host cellular responses associated with complicated UTI. In animals in which microbial colonization was limited to the mucosal surface, inflammation was indistinguishable from that which occurred in shaminoculated controls, and the inflammation resolved by 72 h postinoculation (p.i.) in both groups. However, inflammation persisted in animals with microbial colonization that extended into the deeper layers of the submucosa. Proteome profiling showed that bladder tissues from animals with complicated UTIs had significant increases (P < 0.01) in proteins involved in apoptosis, oxidative stress, and inflammation. Animals with complicated UTIs (2 weeks p.i.) had the highest concentrations of the proinflammatory protein S100A8 (P < 0.005) in bladder tissues, and the levels of S100A8 positively correlated with those of proinflammatory cytokines GRO/KC (P < 0.003) and interleukin-1␣ (P < 0.03) in urine. The bladder uroepithelium was a prominent cell source of S100A8-S100A9 in animals with complicated UTIs (2 weeks p.i.), which was not detected in animals with asymptomatic UTIs (2 weeks p.i.) or in any bladder tissues harvested at earlier p.i. time points. Based on these results, we surmise that invasive colonization of the bladder triggers chronic inflammation and immune dysregulation, which may be critical to struvite formation.Struvite or infection stones form as a result of complicated urinary tract infections (UTI) caused by urease-producing bacteria such as Proteus, Klebsiella, Serratia, and Ureaplasma species (5,8,9,17). Bacterial urease breaks down urea into ammonia, resulting in urine's becoming supersaturated with ammonia. When this occurs, the urine pH rises and the solubility of magnesium ammonium phosphate decreases, leading to crystal deposition and stone formation. Infection is always an underlying cause of struvite urolithiasis (5, 9). Therefore, it is not surprising that known predisposing factors such as renal tubular acidosis, neurogenic bladder, urinary tract obstructions, and chronic use of indwelling catheters (5, 9) are related to elements that increase patient susceptibility to UTI. Although infections usually induce an inflammatory response in the host, to our knowledge, the role of the host immune response as a potential predisposing factor in struvite urolithiasis has not been evaluated or considered to be important in disease pathogenesis. We present data suggesting that the host immune response plays a critical role in the development of struvite stones and that the proinflammatory protein S100A8-S100A9 may play a critical role in the chronic inflammation and immune...