Medical Professional Publications

A Urology/Nephrology Collaboration to Reduce Injury Related to Urinary Tract Infection

Columbus, OH — January 2018

A partnership between urologists and nephrologists at Nationwide Children’s Hospital has laid the groundwork for studying how harmful inflammation and kidney scarring occurs with urinary tract infection (UTI) – and perhaps how they can be stopped.

A 2017 study, published in the American Journal of Physiology: Renal Physiology, reported on a new mouse model of scarring following UTI. Clinician-scientists at Nationwide Children’s led the study team and found that a model with vesicoureteral reflux mirrored the major pathological features observed in children with kidney scarring following UTI.

“It is an easy model in which to initiate a UTI and then look at the role of inflammatory cells of the immune system in the process of kidney scarring,” says Brian Becknell, MD, PhD, a pediatric nephrologist at Nationwide Children’s Hospital and principal investigator in the Center for Clinical and Transitional Research at The Research Institute at Nationwide Children’s. “We can do things like ultrasound to image the kidneys just as we would for a child with a UTI, and we’re able to determine the relationship between the infection, the immune response and the scarring.”

The model showed a relationship between inflammatory cell recruitment and fibrosis, which has prompted Christina Ching, MD, a member of the Section of Urology and the team that developed the mouse model, to further investigate a specific inflammatory pathway.

The cytokine interleukin-6 is important mediator of the inflammatory response, working through different pathways to have both pro- and anti-inflammatory properties. Dr. Ching is investigating the relationship of these two pathways in the body’s natural way of responding to UTI, collaborating with Dr. Becknell in the section of Nephrology. Along with their clinical work, both are principal investigators in the Center for Clinical and Translational Research at Nationwide Children’s.

“Dr. Becknell sees patients as a clinician, and he’s very savvy with the basic science as a PhD researcher,” says Dr. Ching. “I see some of the same patients who need surgery if their infections are severe enough, and as a surgeon, I have access to tissue and urine samples that Dr. Becknell may not. There is a great deal of overlap between urology and nephrology in pediatrics, and so it makes sense for us to do this research together.”

The ultimate goal is to manipulate the body’s responses through immunomodulatory therapies to treat or prevent infection and the damaging renal sequela. Clinicians are largely reactive now, using antibiotics that are already becoming less efficacious.

“Can we identify patients who are more susceptible to infection, or whose infections will be worse?” asks Dr. Ching. “Can we prevent infection? We need new tools, and we believe one of them is helping with how the body defends itself.”


Li, B, Haridas, B, Jackson, A R, Cortado, H, Mayne, N, Kohnken, R, Bolon, B, McHugh, K M, Schwaderer, A L, Spencer, J D, Ching, C B, Hains, D S, Justice, S S, Partida-Sanchez, S, and Becknell, B. Inflammation drives renal scarring in experimental pyelonephritis. American Journal of Physiology: Renal Physiology. 2017 Jan 1; 312(1): F43-F53.

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