Go to JCI Insight
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Alerts
  • Advertising/recruitment
  • Subscribe
  • Contact
  • Current Issue
  • Past Issues
  • By specialty
    • COVID-19
    • Cardiology
    • Gastroenterology
    • Immunology
    • Metabolism
    • Nephrology
    • Neuroscience
    • Oncology
    • Pulmonology
    • Vascular biology
    • All ...
  • Videos
    • Conversations with Giants in Medicine
    • Author's Takes
  • Reviews
    • View all reviews ...
    • 100th Anniversary of Insulin's Discovery (Jan 2021)
    • Hypoxia-inducible factors in disease pathophysiology and therapeutics (Oct 2020)
    • Latency in Infectious Disease (Jul 2020)
    • Immunotherapy in Hematological Cancers (Apr 2020)
    • Big Data's Future in Medicine (Feb 2020)
    • Mechanisms Underlying the Metabolic Syndrome (Oct 2019)
    • Reparative Immunology (Jul 2019)
    • View all review series ...
  • Viewpoint
  • Collections
    • Recently published
    • In-Press Preview
    • Commentaries
    • Concise Communication
    • Editorials
    • Viewpoint
    • Top read articles
  • Clinical Medicine
  • JCI This Month
    • Current issue
    • Past issues

  • Current issue
  • Past issues
  • Specialties
  • Reviews
  • Review series
  • Conversations with Giants in Medicine
  • Author's Takes
  • Recently published
  • In-Press Preview
  • Commentaries
  • Concise Communication
  • Editorials
  • Viewpoint
  • Top read articles
  • About
  • Editors
  • Consulting Editors
  • For authors
  • Alerts
  • Advertising/recruitment
  • Subscribe
  • Contact
Why are diabetics prone to kidney infections?
Michael Zasloff
Michael Zasloff
Published November 12, 2018
Citation Information: J Clin Invest. 2018;128(12):5213-5215. https://doi.org/10.1172/JCI124922.
View: Text | PDF
Commentary

Why are diabetics prone to kidney infections?

  • Text
  • PDF
Abstract

People with diabetes mellitus are at higher risk of developing serious ascending infections of the urinary tract. The traditional explanation has focused on the role of glycosuria in promoting bacterial growth. Using mouse models, Murtha et al. demonstrate that when the intracellular insulin signaling pathway is compromised, antimicrobial defenses are compromised too, and the mice are unable to effectively handle uropathogenic E. coli introduced experimentally into the urinary tract. These observations strongly support the hypothesis that the antimicrobial defenses of the kidney are dependent on insulin, and the urinary tract infections associated with diabetes occur due to reduced expression of these key effectors of innate immunity.

Authors

Michael Zasloff

×

Figure 1

Increased incidence of UTI in diabetics.

Options: View larger image (or click on image) Download as PowerPoint
Increased incidence of UTI in diabetics.
In the healthy urinary tract, t...
In the healthy urinary tract, the epithelium of the urethra, bladder, ureters, and the collecting ducts express and secrete a cocktail of antimicrobial peptides and proteins (AMPs) that effectively constrain fecal uropathogenic E. coli (UPEC) bacteria from ascending into the parenchyma of the kidney. The expression of several of these AMPs, produced by the ICs of the collecting ducts, is dependent on the classical insulin signaling pathway (red arrows). In the direction of the urine flow down the collecting ducts (black arrow), the concentration of the antimicrobial cocktail increases, creating an increasingly more effective immune barrier. In the setting of type 2 diabetes, which is characterized by insulin resistance, expression of the insulin-dependent AMPs is suppressed, creating a less optimal antimicrobial environment, permitting viable microbes to ascend into the collecting ducts. Once attached to the epithelium of the collecting ducts, bacteria invade the epithelial cells, expand in number, and subsequently provoke an acute inflammatory response, clinically recognized as pyelonephritis.
Follow JCI:
Copyright © 2021 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

Sign up for email alerts