Pathophysio

- An alkaline pH favors the crystallization of calcium- and phosphate-containing stones

whereas and acidic urine pH promotes uric acid or cystine stones.

- Ureolytic activity also results in the production of ammonia in close proximity to the
gastric epithelium, causing cell damage and inflammation. In the case of Proteus species
(notably Proteus mirabilis) infection, stones are formed due to the presence of ammonia
and carbon dioxide released by urease action. In addition, the ammonia released is able
to damage the glycosaminoglycan layer, which protects the urothelial surface against
bacterial infection.

- In this context, the administration of urease inhibitors may be an effective therapy for
urease-dependent pathogenic bacteria.

with an upper urinary tract infection with a urease-producing organism, such as Proteus or
Klebsiella. Urease breaks down urinary urea into ammonia plus carbon dioxide: Normal
urine is undersaturated with ammonium phosphate, and struvite stone formation occurs
only when ammonia production is increased and the urine pH is elevated to decrease the
solubility of phosphate.

Alkaline urine has traditionally been associated with Proteus urinary tract infections.1 In the
absence of an infection, clinical findings might suggest other diagnoses, but these are rare in
adolescents. The following are some of the traditional causes of alkaline urine2: (1) urinary tract
infection (Proteus and others); (2) metabolic alkalosis (pyloric stenosis and others); (3) failure of
acidification (renal tubular acidosis, chronic renal failure, or aldosterone abnormalities); (4)
ingestion (salicylate, sodium bicarbonate, acetazolamide, etc); and (5) respiratory alkalosis
(hyperventilation).

Urothelium is a specialized epithelium that lines most of the urinary tract including the renal pelvis,
ureter, bladder, and proximal urethra

The lower GI tract is a common source of UTI causing bacteria, with some strains able to colonize the
vagina 
 In addition, a women’s urethral opening is located closer to the anus making it easier for
bacteria to migrate from the anus to the uretha.

Like other gram-negative bacteria, Proteus species release endotoxin (part of the gram-negative

bacterial cell wall) when invading the bloodstream; thereby triggering additional host inflammatory
responses which can ultimately result in sepsis or systemic inflammatory response syndrome (SIRS), a
severe condition with a 20% to 50% associated incidence of mortality.

Biofilms are a collective of one or more types of microorganisms that can grow on many different
surfaces.