Pathogenesis of gestational urinary tract infection: Urinary obstruction versus immune adaptation and microbial virulence

Abstract

We propose that in pregnant mothers in whom NO is operating at a maximum or near-maximum capacity, and therefore has limited capacity to increase in response to a spreading virulent infection, and in whom TLR4 is down-regulated, the simultaneous limited/diminished responsiveness of both NO and TLR4 plays a key role in a reduced gestational responsiveness to inflammation/infection. This may allow ABU to progress to UTI and urogenital infections, or even to fatal septicaemia. Extensive studies will be required to prove this model in the future. However, in the meantime, this path should be recognised as a possibility, along with the obstructive urinary changes promoted in the past decades. © RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology.