Generally, the causative agents reach the bladder by ascending from the urethra. The process is aided by motility of the organisms. Urine is a good growth medium for many species of bacteria. Species of E. coli that infect the urinary system possess pili that attach specifically to receptors on the cells that line the bladder. Experimental evidence indicates that attachment is followed by death and sloughing of the superficial layer of epithelium, followed by penetration of newly exposed cells by endocytosis. Bacteria ascend the ureters and cause pyelonephritis in many cases of cystitis. Repeated episodes of pyelonephritis cause scarring and shrinkage of the kidneys and are an important cause of kidney failure. ■ pili, pp. 65,187 ■ endocytosis, p. 72

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