دراسة البكتيريا المسببة لالتهابات المسالك البولية والعلامات المناعية الانتقائية, suPAR CFH و FGF23 لدى مرضى الغسيل الكلوي المصابين بالفشل الكلوي

Studying of Uropathogenic Bacteria and Selective Immunological Markers (suPAR, CFH and FGF 23) in Hemodialysis Patients with Renal Failure

Abstract

Infection is a common complication and it is the second leading cause of death in hemodialysis patients. Renal failure (RF) compromises immune defenses and increases susceptibility to infections. Biomarkers such as Complement Factor H (CFH), Soluble urokinase plasminogen activator recopter (suPAR) and Fibroblast Growth Factor 23 (FGF23) have been implicated in renal pathophysiology.
The study aims to characterize and distribute types of bacterial infection that cause urinary tract infection in hemodialysis patients and to evaluate some immunological markers and other parameters in renal failure patients.
The present study is designed to deal with hemodialysis patients, after establishing the diagnosis by a physician and clinical diagnosis at the dialysis center in Imam Al-Hussein Hospital in Karbala province, during the period from October 2024 to January 2025.
A total of 120 blood samples were collected from participants (90 patients and 30 healthy controls), the patient group was sub subdivided into :30 patients with renal failures and UTI, 30 patients with renal failures and without UTI, and 30 patients with UTI and without renal failures , compared with the healthy control group. The age group varied from 10-80 years. urine culture was done for bacterial isolation and identification. Blood samples were collected to measure immunological markers (FGF 23, CFH, suPAR). After that, many analyses were performed, including kidney function test (urea, creatinine), hematological, electrolyte, and parathyroid hormone (PTH) parameters
The current study’s results showed E. coli was the most common bacterial species isolated from patient that occurring in 50% of urinary tract infection patients, then Klebsiella pneumonia (20.00% ), followed by Staphylococcus aureus(11.67%), Enterococcus faecalis (3(5.00%)), Pseudomonas aeruginosa(3(5.00%)), Proteus mirabilis 3(5.00%), then Staphylococcus haemolyticus, Staphylococcus hominins, Staphylococcus saprophyticus and Acinetobacter baumannii (1(1.67%)) for each isolale.
The results showed that there was a significant difference in serum levels of FGF 23, CFH,suPAR, and another parameter at (P-value <0.05 ) when comparisons across patient with control groups. The concentration of all immunological markers was high in patients with renal failure with UTI and without UTI compared to the UTI and control groups. A patient with renal failure had elevated levels of urea, creatinine, phosphorus, Ferritin, and PTH.
There was a positive correlation between FGF23 and CFH (r = 0.768, p < 0.001) as well as between FGF23 and suPAR (r = 0.674, p < 0.001). CFH and suPAR have a robust correlation (r = 0.670, p < 0.001) in addition, positive correlation between FGF-23 and serum phosphorus levels (r = 0.342, p = 0.008).
It can be concluded from the current study that females are more susceptible to infection with UTI than males, and E. coli was the most common causative agent in UTI. The findings highlight the importance of monitoring FGF23, CFH, and suPAR levels in patients with renal impairment. Early detection of elevated levels can facilitate timely interventions to mitigate progression and manage complications. Understanding demographic predispositions to UTIs can inform targeted prevention strategies, particularly among younger females, to reduce infection rates and associated renal complications.