Kidney Disease Patients' Urine Study | News | Loyola Medicine

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Wednesday, May 2, 2018

Urine of Kidney Disease Patients Contains Diverse Mix of Bacteria

Bacteria culture
MAYWOOD, IL – The urine of kidney disease patients contains a diverse mix of bacteria such as Staphylococcus and Streptococcus, according to a study by researchers at Loyola Medicine and Loyola University Chicago.

The bacteria diversity generally was higher among kidney patients who also experienced urinary urgency (sudden, urgent need to urinate). The study findings could lead to new approaches to treating lower urinary tract problems such as urinary urgency and incontinence.

The study by corresponding author Michael J. Zilliox, PhD, first author Holly Kramer, MD, MPH, and colleagues is published in the journal International Urology and Nephrology. The paper is the latest in a series of groundbreaking Loyola studies on the microbiome (community of microorganisms) found in urine.

Urine in healthy patients generally has one or two dominant bacteria, while in kidney disease patients there are many different types of bacteria. It's somewhat like the difference between a manicured lawn and a lawn overrun by dandelions, clover, thistle and other weeds.

The findings are consistent with other research showing microbiome diversity may influence a person's health. For example, low microbiome diversity in the gut has been associated with inflammatory bowel disease while high vaginal microbiome diversity has been linked to bacterial vaginosis.

Physicians traditionally were trained to believe that urine does not contain bacteria. But an earlier Loyola study disproved the common belief that urine is sterile. The new study expanded on these earlier findings.

Researchers examined the urine of 41 women and 36 men who had Stage 3 to Stage 5 kidney disease but were not on dialysis. Patients were age 60 or older and had less than 60 percent of kidney function, with an average of 27 percent of function. Sixty-nine percent of the men and 70 percent of the women also had diabetes. Forty-two percent of the men and 51 percent of the women had urinary urgency and 78 percent of the men and 51 percent of the women had nocturia (excessive nighttime urination).

The study found 19 types of bacteria in the urine samples, and few samples were overwhelmingly dominated by a single genus. In addition to Staphylococcus and Streptococcus, bacteria found in kidney patients' urine included Corynebacterium, Lactobacillus, Gardnerella, Prevotella, Escherichia­/Shigella and Enterobacteriaceae.

Even samples that contained one dominant type of bacteria also contained several other prominent types.

Healthy kidneys secrete antimicrobial peptides in urine to prevent kidney stones and urinary tract infections. It's possible that people with kidney disease secrete fewer peptides, leading to a more diverse microbiome, researchers said.

The study was a collaborative effort that included the departments of nephrology, urology, microbiology and public health sciences. The Loyola Genomics Facility did the sequencing and analysis of the bacterial DNA found in the urine samples.

Dr. Zilliox is an assistant professor in the department of public health sciences of Loyola University Chicago Stritch School of Medicine and scientific director of the Loyola Genomics Facility. Dr. Kramer is an associate professor in the department of public health sciences and in Loyola Medicine's division of nephrology. 
In addition to Drs. Zilliox and Kramer, other co-authors are Gina Kuffel, BS, Krystal Thomas-White, PhD, Alan J. Wolfe, PhD, Kavitha Vellanki, MD, David J. Leehey MD, Vinold K. Bansal, MD, Linda Brubaker, MD, MS, Robert Flanigan MD, Julia Koval, MD, and Anuradha Wadhwa, MD.
The study is titled "The Midstream Urine Microbiome of Adults with Chronic Kidney Disease is Diverse."


About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.