A genetic basis of susceptibility to acute pyelonephritis.
Authors:
Lundstedt, AC McCarthy, S Gustafsson, MC Godaly, G Jodal, U Karpman, D Leijonhufvud, I Linden, C Martinell, J Ragnarsdottir, B Samuelsson, M Truedsson, L Andersson, B Svanborg, C
BACKGROUND: For unknown reasons, urinary tract infections (UTIs) are clustered in certain individuals. Here we propose a novel, genetically determined cause of susceptibility to acute pyelonephritis, which is the most severe form of UTI. The IL-8 receptor, CXCR1, was identified as a candidate gene when mIL-8Rh mutant mice developed acute pyelonephritis (APN) with severe tissue damage. METHODS AND FINDINGS: We have obtained CXCR1 sequences from two, highly selected APN prone patient groups, and detected three unique mutations and two known polymorphisms with a genotype frequency of 23% and 25% compared to 7% in controls (p<0.001 and p<0.0001, respectively). When reflux was excluded, 54% of the patients had CXCR1 sequence variants. The UTI prone children expressed less CXCR1 protein than the pediatric controls (p<0.0001) and two sequence variants were shown to impair transcription. CONCLUSIONS: The results identify a genetic innate immune deficiency, with a strong link to APN and renal scarring.