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UTI in Diabetes Mellitus and Anemia in CKDNadya Zaragita | 130110110184 | C !U"

UTI IN DM

 T#ere are se$eral reas%ns &%r an in'reased &re(uen'y %& UTIs in diabeti' )atients* "e$eral

as)e'ts %& immunity are altered in )atients +it# diabetes* ,%lym%r)#%nu'lear leu-%'yte &un'ti%n is

de)ressed. )arti'ularly +#en a'id%sis is )resent* /eu-%'yte ad#eren'e. '#em%tais. and

)#ag%'yt%sis may be ae'ted* 2y)ergly'emia 'auses neutr%)#il dys&un'ti%n by in'reasing

intra'ellular 'al'ium le$els and inter&ering +it# a'tin and. t#us. dia)edesis and )#ag%'yt%sis*

t#er &a't%rs may als% be in$%l$ed* ,%%r gly'aemi' '%ntr%l. and t#e resulting #y)ergly'aemia.

by itsel& d%es n%t )redi't in'reased ba'terial rates %& multi)li'ati%n and #as n%t al+ays been s#%+n

t% be a ma%r determinant %& eit#er t#e in'iden'e %& ba'teriuria %r its subse(uent '%m)li'ati%ns*

5%men are )r%ne t% UTIs &%r reas%ns. +#i'# are n%t +ell underst%%d* 6$ery %ne +%man

de$el%)s UTI am%ng 7$e +%men* UTI is un'%mm%n in men and '%ntributes t% #a$e larger

'%m)li'ati%ns a&ter initial in&e'ti%n*

ANEMIA IN CKD

a't%rs li-ely '%ntributing t% anemia in '#r%ni' -idney disease in'lude bl%%d l%ss. s#%rtened

red 'ell li&e s)an. $itamin de7'ien'ies. t#e 9uremi' milieu:. eryt#r%)%ietin ;6,< de7'ien'y. ir%n

de7'ien'y. and in=ammati%n*

Blood loss

• Due t% )latelet dys&un'ti%n

• Dialysis main 'ause %& bl%%d l%ss

Shortened red blood cell life span

 T#e li&e s)an %& red 'ells is redu'ed by a))r%imately %ne t#ird in #em%dialysis )atients

Uremic milieu

Uremi' serum #as been s#%+n t% in#ibit )rimary b%ne marr%+ 'ultures %& early eryt#r%id 'ell

lines* T#e le$el and )re$alen'e %& anemia '%rrelate +it# t#e se$erity %& -idney disease* In )atients

+#% #ad been re'ei$ing #em%dialysis. t#e #emat%'rit r%se +#en t#e intensity %& dialysis +as

in'reased. im)lying t#at redu'ing uremia rest%res %r im)r%$es b%ne marr%+ &un'ti%n*

EPO deciency 

6, de7'ien'y is '%nsidered t#e m%st im)%rtant 'ause* ")e'iali>ed )eritubular 'ells t#at)r%du'e 6, are )artially %r '%m)letely de)leted %r inured as renal disease )r%gresses. s% t#at 6,

)r%du'ti%n is ina))r%)riately l%+ relati$e t% t#e degree %& anemia*

6, is )r%du'ed +#en its gene is trans'ribed. in a )r%'ess t#at de)ends %n t#e binding %& a

m%le'ule 'alled #y)%ia?indu'ible &a't%r 1 al)#a t% t#e #y)%ia?res)%nsi$e element %n t#e

eryt#r%)%ietin gene* ,r%du'ti%n %& t#is &a't%r in'reases in states %& relati$e %ygen de7'ien'y*

 T#ere&%re. t#e balan'e bet+een %ygen su))ly and '%nsum)ti%n determines t#e )r%du'ti%n %& t#e

&a't%r and. in turn. t#e 6,*

Iron deciency 

%r reas%ns n%t yet -n%+n. trans&errin le$els in '#r%ni' -idney disease are %ne #al& t% %ne

t#ird %& n%rmal le$els. diminis#ing t#e 'a)a'ity %& t#e ir%n?trans)%rting system* T#is situati%n is t#en

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aggra$ated by t#e +ell?-n%+n inability t% release st%red ir%n &r%m ma'r%)#ages and #e)at%'ytes in

CKD*

Diminis#ed ir%n trans)%rt and a''umulated ir%n st%res are mani&ested as l%+ trans&errin

saturati%n and ele$ated serum &erritin le$els* T#ese '#ara'teristi's suggest t#at t#e inter%rgan ir%n

trans)%rt )at#+ays may be rate?limiting &a't%rs in eryt#r%)%iesis in t#ese )atients* Inter)lay

bet+een in'reased ir%n l%sses and abn%rmal inter%rgan ir%n trans)%rt results in an abs%lute %r

&un'ti%nal ir%n de7'ien'y t#at 'an be '%rre'ted %nly by aggressi$e ir%n re)la'ement t#era)y*

Inammation

C#r%ni' -idney disease s#ares se$eral &eatures %& t#e in=ammat%ry state* 6le$ated 'ir'ulatingle$els %& in=ammat%ry 'yt%-ines su'# as interleu-in?1. ?@. and TN al)#a #a$e been ass%'iated +it#)%%r res)%nse t% 6, treatment in end?stage renal disease* T#ese 'yt%-ines 'an im)air b%ne marr%+&un'ti%n and 'an signi7'antly alter ir%n metab%lism* T#ey are belie$ed t% 'ause t#e destru'ti%n %& BC )re'urs%rs and de'rease t#e number %& eryt#r%)%ietin re'e)t%rs %n )r%genit%r 'ells*

2e)'idin. an end%gen%us antimi'r%bial )e)tide se'reted by t#e li$er. #as been identi7ed as'%ntr%lling t#e le$el %& )lasma ir%n by regulating t#e intestinal abs%r)ti%n %& dietary ir%n. as +ell as

t#e release %& ir%n &r%m ma'r%)#ages and t#e trans&er %& ir%n st%red in t#e #e)at%'ytes* In'rease in#e)'idin le$el in t#e '%urse %& in=ammat%ry disease may be a signi7'ant mediat%r %& t#ea''%m)anying anemia*

e&eren'e

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