Laboratory Investigation

Kidney International (1983) 24, 66–73; doi:10.1038/ki.1983.127

Host immune status in uremia. V. Effect of uremia on resistance to bacterial infection

Isabel A Clarke1, Douglas J Ormrod1 and Thomas E Miller1

1Department of Medicine, University of Auckland, Auckland, New Zealand

Correspondence: Dr T E Miller, Department of Medicine, Auckland Hospital, Park Road, Auckland, New Zealand

Received 8 October 1982; Revised 28 December 1982.

Top

Abstract

Host immune status in uremia. V. Effect of uremia on resistance to bacterial infection. Infection is a frequent complication and cause of death in renal failure. Although it is widely accepted that uremia has an adverse effect on host resistance to infectious disease, this association has not been proven. In the present experiments, the relationship between uremia and susceptibility to infection has been investigated using an animal model of chronic, severe uremia. Lung infections (using Pseudomonas aeruginosa and Klebsiella pneumoniae), bacteremia, peritonitis and subcutaneous infection (using Escherichia coli) were induced in uremic and normal rats and the course of infection compared. The ability of the uremic host to clear Ps. aeruginosa from the lung was marginally impaired in the first 24 hr after the challenge but was normal in the later stages of the infection. Similarly, in the bacteremia study, secondary invasion of the lungs by several other species of bacteria occurred in 33% of the uremic animals. We found no other evidence of impairment of immunity in uremia in the infections that we studied and, taken overall, the results support arguments that uremia per se is unlikely to be an important factor predisposing patients with renal failure to infection.

État immun de l'hôte dans l'urémie. V. Effet de l'urémie sur la résistance a l'infection bactérienne. L'infection est une complication fréquente et une cause de décès dans l'insuffisance rénale. Bien qu'il soit d'une façon générale accepté que l'urémie a un effet adverse sur la résistance de l'hôte à la maladie infectieuse, cette association n'a pas été prouvée. Dans ces expériences, la relation entre l'urémie et la susceptibilité à l'infection a été étudiée en utilisant un modèle animal d'urémie chronique sévère. Des infections pulmonaires (en utilisant Pseudomonas aeruginosa et Klebseilla pneumoniae) une bactériémie, une péritonite et une infection sous-cutanée (en utilisant Escherichia coli) ont été induites chez des rats normaux et urémiques, et les évolutions de l'infection comparées. La capacité de l'hôte urémique de débarrasser le poumon de Ps. aeruginosa était diminuée de façon modérée dans les 24 premières heures après l'induction mais était normale au stade ultérieur de l'infection. De même dans l'étude de la bactériémie, une invasion secondaire des poumons par plusieurs autres espèces de bactéries est survenue chez 33% des animaux urémiques. Nous n'avons pas trouvé d'autres preuves d'une altération de l'immunité au cours de l'urémie dans les infections que nous avons étudiées, et, pris de façon globale, ces résultats sont en faveur de l'idée que l'urémie en soi n'est probablement pas un facteur important prédisposant à l'infection les malades atteints d'insuffisance rénale.

Top

References

  1. Montgomerie JZ, Kalmanson GM, Guze LB: Renal failure and infection. Medicine 47:1–32 1968
  2. Balch HH: The effect of severe battle injury and of post-traumatic renal failure on resistance to infection. Ann Surg 142:145–163, 1955 | PubMed | ISI | ChemPort |
  3. Quadracci LJ, Ringden O, Krzymanski M: The effect of uremia and transplantation on lymphocyte subpopulations. Kidney Int 10:179–184, 1976
  4. Kauffman CA, Manzler AD, Phair JP: Cell-mediated immunity in patients on long-term hemodialysis. Clin Exp Immunol 22:54–61, 1975
  5. Daniels JC, Sakai H, Remmers AR, Sarles HE, Fish JC, Cobb EK, Levin WC, Ritzmann SE: In vitro reactivity of human lymphocytes in chronic uremia: Analysis and interpretation. Clin Exp Immunol 8:213–227, 1971
  6. Boulton-Jones JM, Vick R, Cameron JS, Black PJ: Immune responses in uremia. Clin Nephrol 1:351–360, 1973
  7. Birkeland SA: Uremia as a state of immune deficiency. Scand J Immunol 5:107–115, 1976
  8. Nelson DS, Penrose JM: Macromolecular inhibitor of lymphocyte transformation in serum from patients with chronic renal failure. Aust J Exp Biol Med Sci 51:259–262, 1973
  9. Newberry WM, Sanford JP: Defective cellular immunity in renal failure: Depression of reactivity of lymphocytes to phytohemagglutinin by renal failure serum. J Clin Invest 50:1262–1271, 1971
  10. Silk MR: The effect of uremic plasma on lymphocyte transformation. Invest Urol 5:195–199, 1967
  11. Kasakura S, Lowenstein L: The effect of uremic blood on mixed leukocyte reactions and on cultures of leukocytes with phytohemagglutinin. Transplantation 5:283–289, 1967
  12. Stoloff IL, Stout R, Myerson RM, Havens WP Jr: Production of antibody in patients with uremia. N Engl J Med 259:320–323, 1958
  13. Dammin GJ, Couch NP, Murray JE: Prolonged survival of skin homografts in uremic patients. Ann NY Acad Sci 64:967–976, 1957 | PubMed | ChemPort |
  14. Byron PR, Mallick NP, Taylor G: Immune potential in human uremia. I. Relationship of glomerular filtration rate to depression of immune potential. J Clin Pathol 29:765–769, 1976
  15. Wilson WEC, Kirkpatrick CH, Talmage DW: Suppression of immunologic responsiveness in uremia. Ann Intern Med 62:1–14, 1965
  16. Abrutyn E, Solomons NW, St. Clair L, MacGregor RR, Root RK: Granulocyte function in patients with chronic renal failure: Surface adherence, phagocytosis and bactericidal activity in vitro. J Infect Dis 135:1–8, 1977
  17. Hosking CS, Atkins RC, Scott DF, Holdsworth SR, Fitzgerald MG, Shelton MJ: Immune and phagocytic function in patients on maintenance dialysis and post-transplantation. Clin Nephrol 6:502–505, 1976
  18. Hassner A, Kleter J, Peresecenschi G, Aviram A: Phagocytosis and candidacidal activity of polymorphonuclear leukocytes in uremia. Isr J Med Sci 16:162–164, 1980
  19. Siriwatratananonta P, Sinsakul V, Stern K, Slavin RG: Defective chemotaxis in uremia. J Lab Clin Med 92:402–407, 1978 | PubMed |
  20. Weeke E, Bendixen G: Evaluation of the primary immune response in uremia and after extracorporeal irradiation of the blood. Acta Med Scand 192:267–269, 1972
  21. Baum J, Cestero RVM, Freeman RB: Chemotaxis of the polymorphonuclear leukocyte and delayed hypersensitivity in uremia. Kidney Int 7:S147–S153, 1975
  22. Stinnett JD, Alexander JW, Ogle CK, McClellan MA, Brady D, First R: Immune function of kidney transplant patients in relation to infection. Transplant Proc 10:639–645, 1978
  23. Lahnborg G, Berghem L, Ahlgren T, Groth C-G, Lundgren G, Tillegard A: Reticuloendothelial function in human renal allograft recipients. Transplantation 28:111–115, 1979
  24. Drivas G, Rethymniotakis N, Kalos A, Kaliakmanis N, Melissinos K: Reticuloendothelial phagocytosis in patients with chronic renal failure. Invest Urol 17:241–243, 1979
  25. Souhami RL: Phagocytosis in uremic mice. J Reticuloendothel Soc 12:463–472, 1972
  26. Tse JW, Wiebe LI, Shysh A: Hepatic reticuloendothelial function in the subtotally nephrectomized rat model of chronic uremia. Eur J NuclMed 4:199–201, 1979
  27. Tse JW, Wiebe LI, Ediss C, Shysh A: Clearance and elimination of 125I-Rose Bengal in the subtotally nephrectomized chronically uremic rat. Int J Nucl Med Biol 3:134–137, 1976
  28. Ormrod D, Miller T: Experimental uremia. Description of a model producing varying degrees of stable uremia. Nephron 26:249–254, 1980 | PubMed | ISI | ChemPort |
  29. Lehmann JD, Smith JW, Miller TE, Barnett JA, Sanford JP: Local immune response in experimental pyelonephritis. J Clin Invest 47:2541–2550, 1968
  30. Miller TE, Robinson KB: Experimental pyelonephritis: A new method for inducing pyelonephritis in the rat. J Infect Dis 127:307–310, 1973
  31. Cash HA, Woods DE, McCullough B, Johanson WG Jr, Bass JA: A rat model of chronic respiratory infection with Pseudomonas aeruginosa. Am Rev Respir Dis 119:453–459, 1979 | PubMed |
  32. Jennings MM, Jennings SA, Robson MC, Heggers JP: Mechanisms of host defense and quantitative comparisons of bacterial populations in experimental peritonitis. Can J Microbiol 26:175–178, 1980
  33. Miller TE, Stewart E: Host immune status in uremia. I. Cellmediated immune mechanisms. Clin Exp Immunol 41:115–122, 1980
  34. Stewart E, Miller TE: Host immune status in uremia. II. Serum factors and lymphocyte transformation. Clin Exp Immunol 41:123–129, 1980
  35. Nelson J, Ormrod DJ, Wilson D, Miller TE: Host immune status in uremia. III. Humoral response to selected antigens in the rat. Clin Exp Immunol 42:234–240, 1980
  36. Nelson J, Ormrod DJ, Miller TE: Host immune status in uremia. IV. Phagocytosis and the inflammatory response in vivo. Kidney Int 23:312–319, 1983 | PubMed | ISI | ChemPort |
  37. Balch HH, Evans JR: The influence of acute renal failure on resistance to infection — An experimental study. Ann Surg 144:191–197, 1956
  38. Ginzler E, Diamond H, Kaplan D, Weiner M, Schlesinger M, Seleznick M: Computer analysis of factors influencing frequency of infection in systemic lupus erythematosus. Arthritis Rheum 21:37–44, 1978

Extra navigation

.
ADVERTISEMENT