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Uropathogenic E. coli - An Undergrad Term Paper

Uropathogenic E. coli - An Undergrad Term Paper

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Published by Kelly Stockman
Using peer-reviewed research papers along with what I learned from my Anatomy & Physiology 2 class, I wrote this paper exploring the pathogenesis of uropathogenic E. coli and the body's immune response to invasion.
Using peer-reviewed research papers along with what I learned from my Anatomy & Physiology 2 class, I wrote this paper exploring the pathogenesis of uropathogenic E. coli and the body's immune response to invasion.

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Published by: Kelly Stockman on Jul 11, 2012
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12/29/2012

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 Urinary Tract Infection and the
Body’s Response to Restore Homeostasis
 Kelly StockmanAnatomy & Physiology IISpring 2012
 
DESCRIPTION
The urinary system is comprised of two kidneys, two ureters, the bladder and urethra. It has threeprimary functions: (1) the removal of organic waste materials from body fluids through excretion, (2)the discharge of these waste materials through elimination; and (3) the homeostatic regulation of bloodvolume, blood pressure, and the concentration of solutes in plasma. Other homeostatic mechanismswork to stabilize blood pH, conserve nutrients through reabsorption, and assist the liver indetoxification.A urinary tract infection (UTI) is caused when a pathogen invades the urothelial cells anywhere along theurinary tract. The location of where the infection takes place has different names, such as cystitis for abladder infection or pyelonephritis for a kidney infection. This paper will focus on uncomplicated acutecystitis.Urinary tract infections are the second highest occurring infection in humans, following respiratory tractinfections. UTIs result in as many as seven million office visits and more than one million emergencyroom visits each year. UTIs are more common in women than in men because of differences inanatomy, and changes in sexual maturation, pregnancy and childbirth. 50% of all women willexperience an UTI within her lifetime, while 25% of those women will experience recurrence. Others atrisk are those with catheters, obstructions such as kidney stones, or those with diabetes mellitus. Foruncomplicated acute cystitis, 90% of those infections are caused by uropathogenic Escherichia coli(UPEC).There are several symptoms that occur when the bladder is infected. These include a strong, frequenturge to urinate even though the bladder is empty, pain or burning when urinating, pressure or crampingin the lower abdomen, and the presence of cloudy or bloody urine that may have a strong odor. If leftuntreated, the infection can spread to the kidneys resulting in more severe symptoms including chronicrenal failure. Speaking from personal experience, UTIs are aggravating and they do hurt. The frequent,
strong urges to pee can really disrupt one’s day making
it nearly impossible to get any work done.
HOMEOSTASIS 
The body has several defenses in place to combat invasion by pathogens in order to maintainhomeostasis. With the UTI, such defenses include the composition of urine, the micturition reflex, andthe innate and adaptive immune responses.In The Journal of Clinical Investigation, Donald Kaye, in his article Antibacterial Activity of Human Urine,
wrote, “In
 
discussing the kinetics of urinary tract infection O’Grady and Cattell emphasized as a host
defense mechanism the importance of the mechanical effect of urine flow in diluting and removingbacteria from the urinary tract . . . in the present study, urine from normal individual is often inhibitoryand sometimes bactericidal for growth of these organisms
.” From Kaye’s research study, it
is noted thatthe pH and the concentration of urea provide an inhibitory effect on bacteria. The data showed that ata pH of 5.0, the strongest inhibitory effect was found. Additionally, the greater the concentration of urea, the greater the inhibitory effect on bacterial growth.
 
According to the textbook used for Anatomy and Physiology, the normal range for urine pH is 4.5
 –
8.0,osmolarity ranges from 855-1335 mOsm/L, and the concentration of urea is typically 1.8g/dL. Theresearch study referenced above showed in their data that antimicrobial properties of urine is optimalat 5.0 but still demonstrated inhibitory activity up to 6.0. At a pH greater than 6.0, the inhibitory effectagainst bacteria declined. It also demonstrated that as the osmolarity increased, so did the
concentration of urea. Kaye concluded, “The results of the present study provide evidence for the role
of urea in human urine as an antibacterial agent. They also suggest that within the ranges of concentration commonly achieved in human urine, antibacterial activity is more a function of urea
content than of osmolality, organic acid concentration, or ammonium concentration.”
 As water is reabsorbed in the nephron, the concentration of urea increases where membranes in theascending limb of the nephron loop, the DCT, and the collecting ducts are impermeable to urea. Thevolume of urine is dependent on the movement of water within the nephron. 85% of this water isinvolved in obligatory water reabsorption. The other 15%, about 27 liters per day, is under the influenceof ADH, which is secreted by the posterior pituitary gland. This hormone inserts water channels(aquaporins) along the membranes. This affects the osmotic concentration and as ADH increases, morewater channels appear and more water is reabsorbed, thus concentrating the urine with solutesbecause it is less diluted by water. In the case of a UTI, based on the study mentioned above where theconcentration of urea had the greatest inhibitory effect, the body could respond by increasing ADH,which decreases the volume of urine making it more concentrated with urea. This could inhibit bacterialgrowth in the bladder restoring homeostasis. But on the other hand, increasing urine volume to cause aperson to urinate more will provide more bacterial cleansing of the bladder and urethra.Aside from the composition of urine, the flow of urine through the micturition reflex is anotherimportant defense against invading pathogens. Urine is the end product after the blood has gonethrough filtration in the nephrons, the functional units of the kidneys. After the bodily fluid is filtered inthe proximal convoluted tubule, it then goes through reabsorption in the Loop of Henle in which water,ions, metabolites and nutrients are reabsorbed into the vasa recta. Finally, in the distal convolutedtubule, the active secretion of ions, acids, drugs and toxins takes place. The fluid that is left is whatmakes up urine as it now flows into the collecting ducts of the nephron, then to the papillary duct andon to the minor calyx. The minor calyces join to form a major calyx and two or three major calyces formthe renal pelvis, which is connected to the ureter. Urine then flows down the ureters, one from eachkidney, to fill the urinary bladder.The micturition reflex begins when the stretch receptors in the bladder are stimulated as the bladderbecome full. This sends an impulse along the afferent fibers in the pelvic nerve to the sacral spinal cord.Parasympathetic motor neurons are stimulated and send the signal along the interneurons that relaysensation to the thalamus, then through the projection fibers and on to the cerebral cortex. This iswhen one feels the urge to urinate and the conscious decision is made to go to the bathroom. Whilesitting on the toilet, one voluntarily relaxes the external urethral sphincter, which then causes theinternal urethral sphincter to relax as well. At the same time, parasympathetic preganglionic motorfibers in the pelvic nerve delivers an impulse to the postganglionic neurons that stimulate the detrusormuscle to contract. (The detrusor muscle is the name for the muscle fiber of the bladder.) This elevates

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