Abstract
Vitamin D has emerged as a key factor in innate immunity. Its involvement in the pathogenesis of urinary tract infections (UTIs) has gained a lot of attention recently. The objective of this study is to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and first-time or recurrent UTIs in children. A prospective, case-control study was conducted on 101 pediatric patients, who were divided into two groups: 59 patients with UTIs and 42 age-matched healthy controls. Serum 25(OH)D was determined in each child and expressed in ng/mL. Vitamin D presented significantly lower values in study group subjects than in healthy controls (p < 0.01). Moreover, a significantly higher prevalence of vitamin D insufficiency and deficiency was found in children with UTIs (p < 0.01). Patients with recurrent UTIs presented significantly lower levels of vitamin D than those with first-time UTIs (p = 0.04). Urinary tract abnormalities did not seem to exercise an additional effect upon vitamin D levels within the study group. In conclusion, first-time and recurrent UTIs are associated with lower vitamin D levels. Further studies are necessary to validate our findings, as well as future longitudinal research regarding efficacy of vitamin D supplementation in children with UTIs.
Highlights
Urinary tract infection (UTI) represents one of the most frequent bacterial infections in children [1]
The objective of this study is to investigate the association between serum 25-hydroxyvitamin D (25(OH)D) levels and first-time or recurrent UTIs in children
Distribution of age groups revealed a greater number of patients aged 2 years or more in the study group (p < 0.01)
Summary
Urinary tract infection (UTI) represents one of the most frequent bacterial infections in children [1]. Potential evolution of UTIs towards serious complications such as sepsis and renal scarring, potentially responsible for permanent kidney damage, might be facilitated by a congenital malformation of the genitourinary tract [3]. Both bacteria and host factors play important roles in the development of UTIs [4]. Considered an antimicrobial agent for a long time, vitamin D is involved in urothelium protection, by stimulating the local production of antimicrobial peptides (AMP) [6]. Cathelicidin expression is stimulated by 1,25-dihydroxy vitamin D and protects the urinary tract from infection through induction of cytokine secretion [7]. Uropathogenic E. coli acts directly on these epithelial cells, by downregulating claudin and occludin and disrupting this epithelial barrier [10]
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