HAC (Russian)
RSCI (Russian)
Ulrichsweb (Ulrich’s Periodicals Directory)
Scientific Indexing Services

Risk factors for urinary tract infection in nephrolithiasis

DOI: https://doi.org/10.29296/25877305-2021-10-06

Professor E. Barinov, MD; Kh. Grigoryan, Candidate of Medical Sciences; Yu. Malinin, Candidate
of Medical Sciences M. Gorky Donetsk National Medical University, Donetsk, Donetsk People’s Republic /

Objective: to investigate the impact of renal pelvic and ureteral mucosal infection on the severity of hematuria and inflammation in patients with nephrolithiasis (NLT), to establish risk factors (RFs), and to develop an adequate model for predicting urinary tract infection (UTI). Subjects and methods. The clinical, instrumental, and laboratory data were analyzed in 196 patients with NLT. Methods for pair correlation analysis and for construction of multivariate linear regression models using the EZR v package 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan) were applied to predict the risk of UTI in NLT. The adequacy of the regression model was assessed using the adjusted coefficient of determination (adjusted R-squared value (R2adjusted)). Results. In the presence of UTI, the age of patients was established to have a significant impact on the severity of microhematuria in NLT. In patients with comorbidity of NLT and type 2 diabetes mellitus, UTI was found more frequently (p=0.027), the count of red blood cells in urine increased by 66.3% (p=0.014), and gross hematuria was more common (p=0.034). There was evidence that the size and localization of calculi in the renal pelvis and ureter were RFs for UTI in patients with NLT. The occurrence of UTI in the presence of renal pelvic (>50-mm) and ureteral (>10-mm) calculi was accompanied by the increasing severity of microhematuria. The diagnostic model based on the studied factorial signs demonstrated the high effectiveness of UTI prediction in NLT: the area under the receiver operating characteristic (ROC) curve (AUC) was 0.892 (95% confidence interval (CI), 0.768–0.963); the sensitivity was 88.9% (95% CI, 65.3-98.6), and the specificity was 90.0% (95% CI, 73.5–97.9).

infectious diseases
urinary tract infection
risk prediction

  1. 1. Wolfman D.J., Marko J., Nikolaidis P. et al. ACR Appropriateness Criteria® Hematuria. J Am Coll Radiol. 2020; 17 (5S): S138–S147. DOI: 10.1016/j.jacr.2020.01.028
  2. 2. Chen D., Jiang Ch., Liang X. et al. Early and rapid prediction of postoperative infections following percutaneous nephrolithotomy in patients with complex kidney stones. BJU Int. 2019; 123 (6): 1041–7. DOI: 10.1111/bju.14484
  3. 3. Li Zh., Wang K.-Er., Zhou X.-L. et al. Preoperative Th1/Th2 and related cytokines: Prediction value in postoperative febrile UTI after ureteroscopy in patients with ureteral calculi. Adv Clin Exp Med. 2019; 28 (1): 125–32. DOI: 10.17219/acem/94157
  4. 4. MacCraith E., O’Kelly J., Ryan J. et al. Predictors of emergency department attendance following ureterorenoscopy for urolithiasis. Ir J Med Sci. 2020; 189 (4): 1445–9. DOI: 10.1007/s11845-020-02221-7
  5. 5. Yu-Jang Su, Hsiu-Wu Yang. Risk factors of mortality in patients with purple urine bag syndrome. J Drug Assess. 2019; 8 (1): 21–4. DOI: 10.1080/21556660.2019.1579727
  6. 6. López-de-Andrés A., Albaladejo-Vicente R., Palacios-Ceña D. et al. Time Trends in Spain from 2001 to 2018 in the Incidence and Outcomes of Hospitalization for Urinary Tract Infections in Patients with Type 2 Diabetes Mellitus. Int J Environ Res Public Health. 2020; 17 (24): 9427. DOI: 10.3390/ijerph17249427
  7. 7. Southern J.B., Higgins A.M., Young A.J. et al. Risk Factors for Postoperative Fever and Systemic Inflammatory Response Syndrome After Ureteroscopy for Stone Disease. J Endourol. 2019; 33 (7): 516–22. DOI: 10.1089/end.2018.0789
  8. 8. Dune T.J., Kliethermes S., Mueller E.R. et al. Screening for Microscopic Hematuria in a Urogynecologic Population. Female Pelvic Med Reconstr Surg. 2020; 26 (6): 382–6. DOI: 10.1097/SPV.0000000000000733
  9. 9. Rodriguez-Mañas L. Urinary tract infections in the elderly: a review of disease characteristics and current treatment options. Drugs Context. 2020; 9: 2020-4-13. DOI: 10.7573/dic.2020-4-13
  10. 10. Ozgur B.C., Ekici M., Baykam M.M. et al. Efficiency and Safety of The Retrograde Intrarenal Surgery in Younger Compared to Elderly Patients. J Coll Physicians Surg Pak. 2020; 30 (5): 508–11. DOI: 10.29271/jcpsp.2020.05.508
  11. 11. Ahmad Sh., Hussain A., Ali Khan M. et al. Diabetes mellitus and urinary tract infection: Causative uropathogens, their antibiotic susceptibility pattern and the effects of glycemic status. Pak J Med Sci. 2020; 36 (7): 1550–7. DOI: 10.12669/pjms.36.7.2881
  12. 12. Akash M.S.H., Rehman K., Fiayyaz F. et al. Diabetes-associated infections: development of antimicrobial resistance and possible treatment strategies. Arch Microbiol. 2020; 202 (5): 953–65. DOI: 10.1007/s00203-020-01818-x
  13. 13. Jiang Sh., Wang Y., Zhang Zh. Accuracy of hematuria for predicting non-diabetic renal disease in patients with diabetes and kidney disease: A systematic review and meta-analysis. Diabetes Res Clin Pract. 2018; 143: 288–300. DOI: 10.1016/j.diabres.2018.07.027
  14. 14. Mohanty S., Kamolvit W., Hertting O. Vitamin D strengthens the bladder epithelial barrier by inducing tight junction proteins during E. coli urinary tract infection. Cell Tissue Res. 2020; 380 (3): 669–73. DOI: 10.1007/s00441-019-03162-z
  15. 15. Yuan-Hong J., Jia-Fong J., Yung-Hsiang H. et al. Urothelial health after platelet-rich plasma injection in intractable recurrent urinary tract infection: Improved cell proliferation, cytoskeleton, and barrier function protein expression. Low Urin Tract Symptoms. 2020; 13 (2): 271–8. DOI: 10.1111/luts.12364
  16. 16. Summers L., Kangwantas K., Rodriguez-Grande B. Activation of brain endothelial cells by interleukin-1 is regulated by the extracellular matrix after acute brain injury. Mol Cell Neurosci. 2013; 57: 93–103. DOI: 10.1016/j.mcn.2013.10.007
  17. 17. Labus J., Wöltje K., Stolte K.N. et al. IL-1β promotes transendothelial migration of PBMCs by upregulation of the FN/α5β1 signalling pathway in immortalised human brain microvascular endothelial cells. Exp Cell Res. 2018; 373 (1–2): 99–111. DOI: 10.1016/j.yexcr.2018.10.002
  18. 18. Bhan C., Dash S.P., Dipankar P. et al. Investigation of Extracellular Matrix Protein Expression Dynamics Using Murine Models of Systemic Inflammation. Inflammation. 2019; 42 (6): 2020–31. DOI: 10.1007/s10753-019-01063-5
  19. 19. Yang T., Liu Sh., Hu J. et al. The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy. Biomed Res Int. 2017; 2017: 4832051. DOI: 10.1155/2017/4832051
  20. 20. Fan J., Wan Sh., Liu L. et al. Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy. Urolithiasis. 2017; 45 (6): 573–8. DOI: 10.1007/s00240-017-0963-4