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Sobczak J, Burzyńska M, Sikora A, Wysocka A, Karawani J, Sikora JP. Post-Traumatic Stress Response and Appendicitis in Children-Clinical Usefulness of Selected Biomarkers. Biomedicines 2023; 11:1880. [PMID: 37509519 PMCID: PMC10377452 DOI: 10.3390/biomedicines11071880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/30/2023] Open
Abstract
Acute appendicitis is an inflammatory process which is one of the most frequent global causes of surgical interventions in children. The goal of the study was to determine whether acute phase proteins, that is, C-reactive protein (CRP), procalcitonin (PCT) and neutrophil gelatinase-associated lipocalin (NGAL), interleukin 6 (IL-6), transforming growth factor-beta1 (TGF-β1) and cortisol (HC) play a role in the pathomechanism of post-trauma stress response of the organism and to establish the impact of the applied surgical procedure and/or of inflammation on their concentrations. An additional purpose was to establish the clinical usefulness of the studied biomarkers in the diagnostics of appendicitis. CRP concentrations were quantified via the immunoturbidimetric method, while the levels of IL-6 and PCT were assessed using a bead-based multiplexed immunoassay system in a microplate format (Luminex xMAP technology); NGAL, TGF-β1 and cortisol concentrations were determined via the enzyme-linked immunosorbent assay (ELISA) technique. All the investigated biomarkers were assayed twice, i.e., immediately before the surgery and 12-24 h after its completion. Significant increases in CRP, IL-6 and PCT concentrations were found in all children subjected to laparoscopic surgeries (p = 0.001, p = 0.006, and p = 0.009, respectively) and open (classic) surgeries (p = 0.001, p = 0.016, and p = 0.044, respectively) compared to the initial concentrations. The patients undergoing classical surgery moreover presented with significant (p = 0.002, and p = 0.022, respectively) increases in NGAL and TGF-β1 levels after the procedures. In a group of children undergoing laparoscopic surgery, the appendicitis induced an increase in cortisol concentration, whereas in patients undergoing classical surgery the increase in the levels of this biomarker was caused by the type of performed surgical procedure. Simultaneously assaying the levels of CRP, NGAL and IL-6 (p = 0.008, p = 0.022, and p = 0.000, respectively) may prove useful in clinical practice, enabling the diagnosis of appendicitis in paediatric patients reporting to a hospital with abdominal pains, in addition to data from anamnesis and from clinical or ultrasound examination. The performed study confirms the participation of examined biomarkers in the pathomechanism of post-injury stress reaction of the organism to surgical trauma.
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Affiliation(s)
- Jarosław Sobczak
- Department of Paediatric Emergency Medicine, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
- Department of Management and Logistics in Healthcare, Medical University of Łódź, ul. Lindleya 6, 90-131 Łódź, Poland
| | - Monika Burzyńska
- Department of Epidemiology and Biostatistics, Chair of Social and Preventive Medicine, Medical University of Łódź, ul. Żeligowskiego 7/9, 90-752 Łódź, Poland
| | - Anna Sikora
- Department of Intensive Care and Anaesthesiology, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
| | - Anna Wysocka
- Department of Paediatric Surgery and Oncology, Chair of Surgical Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
| | - Jakub Karawani
- Faculty of Medicine, Lazarski University, ul. Świeradowska 43, 02-662 Warsaw, Poland
| | - Janusz P Sikora
- Department of Paediatric Emergency Medicine, 2nd Chair of Paediatrics, Central Clinical Hospital, Medical University of Łódź, ul. Sporna 36/50, 91-738 Łódź, Poland
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Biomarker bei ureteropelviner Stenose. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01644-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Early detection of ureteropelvic junction obstruction in neonates with prenatal diagnosis of renal pelvis dilatation using 1H NMR urinary metabolomics. Sci Rep 2022; 12:13406. [PMID: 35927301 PMCID: PMC9352869 DOI: 10.1038/s41598-022-17664-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Renal pelvis dilatation (RPD) is diagnosed in utero on prenatal ultrasonography (US) and can resolve spontaneously. However, isolated RPD can also reflect ureteropelvic junction obstruction (UPJO), which requires surgical treatment to prevent progressive renal deterioration. The diagnosis of UPJO can only be confirmed after birth with repeat US and renal isotope studies. 1H Nuclear Magnetic Resonance spectroscopy (NMR) was performed on urine of newborns with prenatally diagnosed unilateral RPD and healthy controls to identify specific urinary biomarkers for UPJO. The original combination of EigenMS normalization and sparse partial-least-squares discriminant analysis improved selectivity and sensitivity. In total, 140 urine samples from newborns were processed and 100 metabolites were identified. Correlation network identified discriminant metabolites in lower concentrations in UPJO patients. Two main metabolic pathways appeared to be impaired in patients with UPJO i.e. amino acid and betaine metabolism. In this prospective study, metabolic profiling of urine samples by NMR clearly distinguishes patients who required surgery for UPJO from patients with transient dilatations and controls. This study will pave the way for the use of metabolomics for the diagnosis of prenatal hydronephrosis in clinical routine.
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Seifriedova Z, Flogelova H, Sarapatka J, Smakal O, Student V. The use of biomarkers in the diagnosis and treatment of obstruction of the upper urinary tract in children. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022; 166:243-250. [PMID: 35147136 DOI: 10.5507/bp.2022.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Antenatal hydronephrosis, dilatation of the upper urinary tract (UUTD), is a common finding on prenatal ultrasound. One of the most common causes is ureteropelvic junction (UPJ) obstruction. Although such prenatally diagnosed UUTD resolves spontaneously in most newborns, further examination of these children is advocated to prevent possible irreversible kidney damage, and ultrasound is mainly used for this. If the dilatation persists or becomes symptomatic, it is necessary to proceed to other relatively demanding and invasive diagnostic examinations for these small patients, where the question of the right timing of indications for possible surgical solutions is still unclear. For this reason, various biomarkers have been investigated in a number of clinical trials as potential mini-invasive diagnostic tools for determining when upper urinary tract dilatation in such children poses a threat to the developing kidneys and they should be operated on, and vice versa, when to proceed conservatively. The aim of this article is to review the findings on and current issues with the use of biomarkers in the diagnosis and treatment of UPJ obstruction in children.
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Affiliation(s)
- Zuzana Seifriedova
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Hana Flogelova
- Department of Pediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
| | - Jan Sarapatka
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Oldrich Smakal
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - Vladimir Student
- Department of Urology, University Hospital Olomouc and Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
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Xiao M, Zheng L, Zhang X, Duan X, Hang T, Lu S, Liu S, Lin H. Renal-on-Chip Microfluidic Platform with a Force-Sensitive Resistor (ROC-FS) for Molecular Pathogenesis Analysis of Hydronephrosis. Anal Chem 2021; 94:748-757. [PMID: 34951537 DOI: 10.1021/acs.analchem.1c03155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hydronephrosis is one of the most common diseases in urology. However, due to the difficulties in clinical trials and the lack of reliable in vitro platforms, the surgical indicators are not clear. Herein, the renal-on-chip with a force-sensitive resistor microfluidic platform was established to simulate the state of hydronephrosis. Cell counting kit-8 (CCK-8) and tight junction protein claudin-2 were detected on a renal-on-chip microfluidic platform with a force-sensitive resistor (ROC-FS). The results indicated that the ROC-FS had normal physiological functions and the cell viability on ROC-FS declined to around 40% after 48 h of hydronephrosis-simulated treatment. In addition, proteomics analysis of 15 clinical ureteropelvic junction obstruction (UPJO) samples showed that compared with normal children, a total of 50 common proteins were differentially expressed in UPJO children (P < 0.05, |log2fold change| ≥ 1). Metabolomic analysis of 39 clinical UPJO samples showed that a total of 241 metabolisms were dysregulated. Subsequent immunofluorescence and enzyme-linked immunosorbent assay (ELISA) analysis using ROC-FS were performed to identify the clinical multi-omics results for screening. All results pointed out that the TGF-β-related signaling pathways and arginine-related metabolism signaling pathways were dysregulated and α-SMA, AGT, and AGA might be the potential biomarkers of hydronephrosis. In addition, correlation analysis of AGT and KLK1 with differential renal function (DRF) from clinical samples indicated good correlation coefficients (R2 0.923, 0.8742, 0.6412, and 0.8347). This demonstrates the state of hydronephrosis could be significantly correlated with the biomarkers. These findings could provide a reliable reference for determining surgical biomarkers clinically, and ROC could be further used in the analysis of other kidney diseases.
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Affiliation(s)
- Mingming Xiao
- Shanghai Key Laboratory of Atmospheric Particle Pollution Prevention (LAP3), Department of Environmental Science & Engineering, Fudan University, 2005 Songhu Road, Shanghai 200438, China
| | - Lulu Zheng
- Engineering Research Center of Optical Instrument and System, Ministry of Education, Shanghai Key Lab of Modern Optical System, University of Shanghai for Science and Technology, 526 Jugong Road, Shanghai 200093, China
| | - Xinlian Zhang
- Shanghai Key Laboratory of Atmospheric Particle Pollution Prevention (LAP3), Department of Environmental Science & Engineering, Fudan University, 2005 Songhu Road, Shanghai 200438, China
| | - Xiaoxiao Duan
- Shanghai Key Laboratory of Atmospheric Particle Pollution Prevention (LAP3), Department of Environmental Science & Engineering, Fudan University, 2005 Songhu Road, Shanghai 200438, China
| | - Tian Hang
- Department of Pediatric Surgery, Jiaxing Women and Children Hospital Affiliated to Jiaxing University, 2468 East Zhonghuan Road, Jiaxing, Zhejiang 314050, China
| | - Shijiao Lu
- Department of Pediatric Surgery, Jiaxing Women and Children Hospital Affiliated to Jiaxing University, 2468 East Zhonghuan Road, Jiaxing, Zhejiang 314050, China
| | - Sixiu Liu
- Shanghai Key Laboratory of Atmospheric Particle Pollution Prevention (LAP3), Department of Environmental Science & Engineering, Fudan University, 2005 Songhu Road, Shanghai 200438, China
| | - Houwei Lin
- Department of Pediatric Surgery, Jiaxing Women and Children Hospital Affiliated to Jiaxing University, 2468 East Zhonghuan Road, Jiaxing, Zhejiang 314050, China
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The Usefulness of Urinary Periostin, Cytokeratin-18, and Endoglin for Diagnosing Renal Fibrosis in Children with Congenital Obstructive Nephropathy. J Clin Med 2021; 10:jcm10214899. [PMID: 34768419 PMCID: PMC8585114 DOI: 10.3390/jcm10214899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/11/2021] [Accepted: 10/20/2021] [Indexed: 12/28/2022] Open
Abstract
Congenital obstructive nephropathy (CON) leads to renal fibrosis and chronic kidney disease. The aim of the study was to investigate the predictive value of urinary endoglin, periostin, cytokeratin-18, and transforming growth factor-β1 (TGF-β1) for assessing the severity of renal fibrosis in 81 children with CON and 60 controls. Children were divided into three subgroups: severe, moderate scars, and borderline lesions based on 99mTc-ethylenedicysteine scintigraphy results. Periostin, periostin/Cr, and cytokeratin-18 levels were significantly higher in the study group compared to the controls. Children with severe scars had significantly higher urinary periostin/Cr levels than those with borderline lesions. In multivariate analysis, only periostin and cytokeratin-18 were independently related to the presence of severe and moderate scars, and periostin was independently related to borderline lesions. However, periostin did not differentiate advanced scars from borderline lesions. In ROC analysis, periostin and periostin/Cr demonstrated better diagnostic profiles for detection of advanced scars than TGF-β1 and cytokeratin-18 (AUC 0.849; 0.810 vs. 0.630; 0.611, respectively) and periostin for detecting borderline lesions than endoglin and periostin/Cr (AUC 0.777 vs. 0.661; 0.658, respectively). In conclusion, periostin seems to be a promising, non-invasive marker for assessing renal fibrosis in children with CON. CK-18 and TGF-β1 demonstrated low utility, and endoglin was not useful for diagnosing advanced scars.
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Valério FC, Lemos RD, de C Reis AL, Pimenta LP, Vieira ÉL, Silva ACE. Biomarkers in vesicoureteral reflux: an overview. Biomark Med 2020; 14:683-696. [PMID: 32643393 DOI: 10.2217/bmm-2019-0378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aim: This article aimed to review the role of cytokines, chemokines, growth factors and cellular adhesion molecules as biomarkers for vesicoureteral reflux (VUR) and reflux nephropathy (RN). Methods: We reviewed articles from 1979 onward by searching PubMed and Scopus utilizing the combination of words: 'VUR' or 'RN' and each one of the biomarkers. Results: Genetic, inflammatory, fibrogenic, environmental and epigenetic factors responsible for renal scarring need to be better understood. TGF-β, IL-10, IL-6, IL-8 and TNF seem to exert a role in VUR particularly in RN based on the current literature. Serum levels of procalcitonin have been also associated with high-grade VUR and RN. These molecules should be more intensively evaluated as potential biomarkers for renal scarring in VUR. Conclusion: Further studies are necessary to define which molecules will really be of utility in clinical decisions and as therapeutic targets for VUR and RN.
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Affiliation(s)
- Flávia C Valério
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Brazil.,Pediatric Nephrology Unit, Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil
| | - Renata D Lemos
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Ana L de C Reis
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Letícia P Pimenta
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Érica Lm Vieira
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Brazil
| | - Ana Cs E Silva
- Laboratório Interdisciplinar de Investigação Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Brazil.,Pediatric Nephrology Unit, Hospital das Clínicas, UFMG, Belo Horizonte, MG, Brazil
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Paraboschi I, Mantica G, Dalton NR, Turner C, Garriboli M. Urinary biomarkers in pelvic-ureteric junction obstruction: a systematic review. Transl Androl Urol 2020; 9:722-742. [PMID: 32420179 PMCID: PMC7215034 DOI: 10.21037/tau.2020.01.01] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Antenatal hydronephrosis is a common finding detected on prenatal ultrasound. Although hydronephrosis will spontaneously resolve in the majority of newborns, there is a significant amount of cases that will worsen with the risk of a progressive and permanent loss of renal function. There is an increasing concern among experts that the current criteria for evaluation of clinically significant obstructions are limited. Our aim is to provide a systematic review of the available literature on biomarkers of renal injury, potential targets for diagnosis and prognosis of children with hydronephrosis. The main search was conducted in the electronic databases from inception through March 2019 using various combinations of the keywords: pelvic-ureteric [All Fields] AND junction [All Fields] AND obstruction [All Fields] AND “biomarkers” [MeSH Terms] OR “biomarkers” [All Fields] OR “biomarker” [All Fields]. To broaden the research, additional articles were identified through hand-searching review of the references reported in each study previously selected. Histopathological studies, studies with no control group or with participants suffering from concomitant urological diseases and articles published in language other than English were excluded. Data on study design, sample size, average patient age, hydronephrosis definition used, surgical indication, duration and pattern of follow-up, details on biomarker studied, diagnostic test characteristics, area under the curve (AUC) on receiver operating characteristic (ROC) analysis with the best cut-off (BCO) values, sensitivity, specificity and outcomes were all collected. 38 articles analysing 41 biomarkers were selected. The most frequent proteins investigated were neutrophil gelatinase-associated lipocalin (NGAL) (n=9; 23.7%), monocyte chemotactic peptide-1 (MCP1) (n=8; 21.1%), transforming growth factor β1 (TGFβ1) (n=7; 18.4%), epidermal growth factor (EGF) (n=6; 15.8%) and kidney injury molecule 1 (KIM 1) (n=6; 15.8%). Twenty-seven (71.1%) studies evaluated the effect of pyeloplasty on voided urine biomarker concentrations, comparing their values before and after surgery. Twelve (31.6%) studies investigated the correlation between preoperative biomarker concentration and the anterior posterior renal pelvis diameter (DAP) while 20 (52.6%) studies investigated the correlation between preoperative biomarker concentration with the split renal function (SRF) measured on nuclear medicine assessments. ROC curves were used to investigate the performance of urinary biomarkers in the total patient data set in 27 (71.1%) studies. Some biomarkers offer promising results. However, a critic analysis of the published studies demonstrates bias and lack of consistency suggesting that larger multicentre and carefully designed prospective studies are still needed to evaluate the clinical usefulness of urinary biomarkers in the diagnosis and follow-up of children with congenital obstructive hydronephrosis.
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Affiliation(s)
- Irene Paraboschi
- Paediatric Surgery Unit, Istituto Giannina Gaslini, DiNOGMI, University of Genova, Genoa, Italy
| | - Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genova, Genova, Italy
| | - Neil R Dalton
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Charles Turner
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
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Value of urinary carbohydrate antigen 19-9 to predict failure of conservative management in children with ureteropelvic junction obstruction. J Pediatr Surg 2019; 54:1650-1653. [PMID: 30340877 DOI: 10.1016/j.jpedsurg.2018.09.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the role of urinary carbohydrate antigen 19-9 (CA19-9) measurement in determining optimal management of ureteropelvic junction obstruction (UPJO) and predicting failure of conservative management. PATIENTS AND METHODS Children with UPJO diagnosed between December 2012 and April 2015 were included. Depending on clinical and para-clinical findings, patients were divided into three groups: Group 1 consisted of patients who were considered for non-operative management with improvement of the condition during the course of follow-up. Group 2 were suitable for observation; however due to deterioration of condition pyeloplasty was indicated after a period of observation. Group 3 patients required immediate pyeloplasty. Urinary CA19-9 was measured in all patients at baseline and compared between the study groups. RESULTS A total of 112 children (115 affected kidneys) with UPJO and mean age of 18.6 ± 3.3 months were assessed. Group 1, 2, and 3 consisted of 54(48.2%), 24(21.4%), and 34(30.4%) patients, respectively. Mean baseline urinary CA19-9 was 37.83 ± 5.20, 145.45 ± 18.38 and 244.62 ± 41.42 in groups 1, 2 and 3, respectively. Multivariate analysis showed that both CA19-9 and APD are independent predictors of need for surgery in patients on observation. ROC curve analysis revealed that urinary CA19-9 level at cut off value of 52.6 U/mL had sensitivity of 92.0% and specificity of 70.9% in predicting failure of non-operative management. CONCLUSION Higher urinary CA19-9 level is associated with failure of non-operative management in patients with UPJO. Such patients may require close follow-up and assessments to prevent irreversible damage to the kidney. TYPE OF STUDY Study of Diagnostic Test. LEVEL OF EVIDENCE Level II.
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Kostic D, Dos Santos Beozzo GPN, do Couto SB, Kato AHT, Lima L, Palmeira P, Krebs VLJ, Bunduki V, Francisco RPV, Zugaib M, de Carvalho WB, Koch VHK. First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction. Pediatr Nephrol 2019; 34:1117-1128. [PMID: 30694385 DOI: 10.1007/s00467-019-4195-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 01/06/2019] [Accepted: 01/09/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. Use of renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and prevention or minimization of definitive renal damage. METHODS This longitudinal, prospective study analyzed the first-year profile of two serum renal biomarkers: creatinine (sCr) and cystatin C (sCyC); and six urinary renal biomarkers: neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-β1), retinol-binding protein (RBP), cystatin C (uCyC), and microalbuminuria (μALB) in a cohort of 37 infants with UTO divided into three subgroups: 14/37 with unilateral hydro(uretero)nephrosis, 13/37 with bilateral hydro(uretero)nephrosis, and 10/37 patients with lower urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. RESULTS All urine biomarkers showed significantly higher values at the first month of life (p ≤ 0.009), while NGAL (p = 0.005), TGF-ß1 (p < 0.001), and μALB (p < 0.001) were high since birth compared to controls. Best single biomarker performances were RBP in bilateral hydronephrosis and LUTO subgroups and KIM-1 in unilateral hydronephrosis subgroup. Best biomarker combination results for all subgroups were obtained by matching RBP with TGF-ß1 or KIM-1 and NGAL with CyC ([AUC] ≤ 0.934; sensitivity ≤ 92.4%; specificity ≤ 92.8%). CONCLUSIONS RBP, NGAL, KIM-1, TGF-ß1, and CyC, alone and especially in combination, are relatively efficient in identifying surgically amenable congenital UTO and could be of practical use in indicating on-time surgery.
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Affiliation(s)
- Dusan Kostic
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil.
| | | | - Saulo Brasil do Couto
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil
| | - André Henrique Teruaki Kato
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil
| | - Laila Lima
- Laboratory of Clinical Investigations (LIM-36)-Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Patricia Palmeira
- Laboratory of Clinical Investigations (LIM-36)-Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Lúcia Jornada Krebs
- Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Victor Bunduki
- Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcelo Zugaib
- Department of Obstetrics and Gynecology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Werther Brunow de Carvalho
- Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Vera Hermina Kalika Koch
- Pediatric Nephrology Unit, Department of Pediatrics, Instituto da Criança, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas Carvalho de Aguiar, 647, São Paulo, CEP: 05403-000, SP, Brazil
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The role of renal biomarkers to predict the need of surgery in congenital urinary tract obstruction in infants. J Pediatr Urol 2019; 15:242.e1-242.e9. [PMID: 30979613 DOI: 10.1016/j.jpurol.2019.03.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/08/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The diagnosis of renal function impairment and deterioration in congenital urinary tract obstruction (UTO) continues to be extremely challenging. The use of new renal biomarkers in this setting may favor early renal injury detection, allowing for a reliable choice of optimal therapeutic options and the prevention or minimization of definitive renal damage. OBJECTIVE The aim of the study was to investigate a selection of promising biomarkers of renal injury with the intention of evaluating and comparing their profile with clinically based decisions for surgical intervention of infants with congenital obstructive uropathies. STUDY DESIGN The first-year profile of renal biomarkers, serum creatinine (sCr), serum and urine cystatin C (CyC), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), transforming growth factor beta-1 (TGF-β1), retinol-binding protein (RBP), and microalbuminuria (μALB), was analyzed in a cohort of 37 infants with congenital UTO, divided into three subgroups, 14 cases with grade III unilateral hydro(uretero)nephrosis, 13 cases with grade III bilateral hydro(uretero)nephrosis, and 10 cases with low urinary tract obstruction (LUTO), compared with 24 healthy infants matched by gestational age and birth weight. Serum and urine samples were stored at -70 °C and thereafter analyzed by quantitative enzymatic immunoassay. RESULTS Compared with the control group (Figure), all renal biomarker values were significantly increased in patients (P ≤ 0.02). In the unilateral hydronephrosis and LUTO group, RBP (P ≤ 0.043), NGAL (P ≤ 0.043), KIM-1 (P ≤ 0.03), and TGF-β1 (P ≤ 0.034) values dropped significantly after surgery. Neutrophil gelatinase-associated lipocalin alone and in combination with urine and serum CyC demonstrated the best performance in determining the need for surgery (area under the curve, 0.801 and 0.881, respectively). Biomarker profile analysis was suggestive of surgical intervention in 55.4% (7/13) of non-operated cases, and most of the biomarker values were above the cutoff levels within at least 3 months before the clinically based surgical decision in 58% (14/24) of all operated patients. DISCUSSION To the best of the authors' knowledge, this is the first study to present the clinical use of selected group of serum and urinary biomarkers in the setting of UTO to distinguish between patients who would benefit from surgery intervention. The most promising results were obtained using NGAL, RBP, TGF-β1, and KIM-1, especially in the unilateral hydro(uretero)nephrosis and LUTO subgroups when compared with the control group. CONCLUSIONS Urine biomarkers, alone and in combination, demonstrated high potential as a non-invasive diagnostic tool for identifying infants who may benefit from earlier surgical intervention.
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ROLE OF THE FIBROTIC MARKERS FOR PYELONEPHRITIS IN INFANTS. WORLD OF MEDICINE AND BIOLOGY 2019. [DOI: 10.26724/2079-8334-2019-2-68-121-126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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13
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Jackson L, Woodward M, Coward RJ. The molecular biology of pelvi-ureteric junction obstruction. Pediatr Nephrol 2018; 33:553-571. [PMID: 28286898 PMCID: PMC5859056 DOI: 10.1007/s00467-017-3629-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/16/2017] [Accepted: 02/17/2017] [Indexed: 12/17/2022]
Abstract
Over recent years routine ultrasound scanning has identified increasing numbers of neonates as having hydronephrosis and pelvi-ureteric junction obstruction (PUJO). This patient group presents a diagnostic and management challenge for paediatric nephrologists and urologists. In this review we consider the known molecular mechanisms underpinning PUJO and review the potential of utilising this information to develop novel therapeutics and diagnostic biomarkers to improve the care of children with this disorder.
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Affiliation(s)
- Laura Jackson
- Bristol Renal Group, University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY, UK. .,Bristol Royal Hospital for Children, Bristol, UK.
| | - Mark Woodward
- 0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, Bristol, UK
| | - Richard J. Coward
- 0000 0004 1936 7603grid.5337.2Bristol Renal Group, University of Bristol, Dorothy Hodgkin Building, Whitson Street, Bristol, BS1 3NY UK ,0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, Bristol, UK
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Miranda EP, Duarte RJ, de Bessa J, Lopes RI, Srougi V, Andrade HS, Bandeira RAST, Arap MA, Mitre AI, Viana NI, Reis ST, Leite KRM, Srougi M. The role of urinary KIM-1, NGAL, CA19-9 and β2-microglobulin in the assessment of ureteropelvic junction obstruction in adults. Biomarkers 2017; 22:682-688. [PMID: 28103129 DOI: 10.1080/1354750x.2017.1284264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE The objective of this study is to evaluate the diagnostic properties of urinary biomarkers in adults with ureteropelvic junction obstruction: KIM-1, NGAL, CA19-9, and β2-microglobulin. We also assessed urinary biomarker concentrations following pyeloplasty. MATERIAL AND METHODS We prospectively studied adults from December 2013 to February 2015. We included 47 patients with a mean age of 38.6 ± 12.7 years. Each patient provided four samples of voided urine for biomarker measurement, one at pre-operative consultation and the others at 1, 3, and 6 months of post-operative follow-up. The control group consisted of 40 healthy individuals with no hydronephrosis on ultrasound evaluation. RESULTS KIM-1 had an area under the curve of 0.79 (95% CI 0.70-0.89), NGAL 0.71 (95% CI 0.61-0.83), CA19-9 0.70 (95% CI 0.60-0.81), and β2-microgloblin 0.61 (95% CI 0.50-0.73). KIM-1 was the most sensitive marker with a cut-off of 170.4 pg/mg creatinine (sensitivity 91.4%, specificity 59.1%), whereas CA19-9 was the most specific with a cut-off of 51.3 U/mg creatinine (sensitivity 48.9%, specificity 88.0%). Urinary concentrations of biomarkers decreased after pyeloplasty. CONCLUSIONS The evaluation of urinary biomarkers is useful in adults undergoing pyeloplasty. KIM-1, NGAL, and CA19-9 were elevated and significantly decreased after surgery.
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Affiliation(s)
- Eduardo P Miranda
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Ricardo J Duarte
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - José de Bessa
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Roberto I Lopes
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Victor Srougi
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Hiury S Andrade
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Rodolfo A S T Bandeira
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Marco A Arap
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Anuar I Mitre
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Nayara I Viana
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Sabrina T Reis
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Katia R M Leite
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
| | - Miguel Srougi
- a Division of Urology, Hospital das Clinicas , University of Sao Paulo Medical School , Sao Paulo , Brazil
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Top T, Sekerci CA, Isbilen-Basok B, Tanidir Y, Tinay I, Isman FK, Akbal C, Simsek F, Tarcan T. The effect of intradetrusor botulinum neurotoxin type A on urinary NGF, TGF BETA-1, TIMP-2 levels in children with neurogenic detrusor overactivity due to myelodysplasia. Neurourol Urodyn 2017; 36:1896-1902. [DOI: 10.1002/nau.23207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 12/06/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Tuncay Top
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
| | - Cagri Akin Sekerci
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
| | - Banu Isbilen-Basok
- Deparment of Biochemistry; Tepecik Training and Research Hospital; Izmir Turkey
| | - Yiloren Tanidir
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
| | - Ilker Tinay
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
| | - Ferruh Kemal Isman
- Department of Biochemistry, School of Medicine; Medeniyet University; Istanbul Turkey
| | - Cem Akbal
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
| | - Ferruh Simsek
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
| | - Tufan Tarcan
- Department of Urology; School of Medicine; Marmara University; Istanbul Turkey
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Magalhães P, Schanstra JP, Carrick E, Mischak H, Zürbig P. Urinary biomarkers for renal tract malformations. Expert Rev Proteomics 2016; 13:1121-1129. [PMID: 27791437 DOI: 10.1080/14789450.2016.1254555] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Renal tract malformations (RTMs) are congenital anomalies of the kidneys and urinary tract, which are the major cause of end-stage renal disease in children. Using immunoassay-based approaches (ELISA, western blot), individual urinary proteins including transforming growth factor β, tumor necrosis factor and monocyte attractant proteins 1 were found to be associated to RTMs. However, only mass spectrometry (MS) based methods leading to the identification of panels of protein-based markers composed of fragments of the extracellular matrix allowed the prediction of progression of RTMs and its complications. Areas covered: In this review, we summarized relevant studies identified in "Pubmed" using the keywords "urinary biomarkers" and "proteomics" and "renal tract malformations" or "hydronephrosis" or "ureteropelvic junction obstruction" or "posterior urethral valves" or "vesicoureteral reflux". These publications represent studies on potential protein-based biomarkers, either individually or combined in panels, of RTMs in human and animal models. Expert commentary: Successful use in the clinic of these protein-based biomarkers will need to involve larger scale studies to reach sufficient power. Improved performance will potentially come from combining immunoassay- and MS-based markers.
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Affiliation(s)
- Pedro Magalhães
- a Mosaiques Diagnostics GmbH , Hannover , Germany.,b Department of Pediatric Nephrology, Hannover Medical School , Hannover , Germany
| | - Joost P Schanstra
- c Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease , Toulouse , France.,d Université Toulouse III Paul-Sabatier , Toulouse , France
| | - Emma Carrick
- e BHF Glasgow Cardiovascular Research Centre , Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - Harald Mischak
- a Mosaiques Diagnostics GmbH , Hannover , Germany.,e BHF Glasgow Cardiovascular Research Centre , Institute of Cardiovascular and Medical Sciences, University of Glasgow , Glasgow , UK
| | - Petra Zürbig
- a Mosaiques Diagnostics GmbH , Hannover , Germany
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Effects of transforming growth factor on the developing embryonic ureter: An in-vitro megaureter model in mice. J Pediatr Urol 2016; 12:310.e1-310.e4. [PMID: 27321555 DOI: 10.1016/j.jpurol.2016.04.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION It is generally agreed that the cause of a megaureter is narrowing at the vesicoureteral junction, with a functional obstruction arising from an aperistaltic, juxtavesical segment that is unable to transport urine at an acceptable rate. Histological examinations of megaureter specimens have reported several histological analyses, and the pathogenic role of transforming growth factor is still a matter of speculation. OBJECTIVE To evaluate whether transforming growth factor-beta (TGF-β) and its receptors (TGFRs) are expressed during ureterovesical junction (UVJ) and lower ureter development in mice, and whether exogenous TGF-β might postpone the maturation of smooth muscle cells, in the pathogenesis of megaureter using an embryonic organ-culture model. METHODS Expression of TGF-β and TGFRs on the lower ureter and UVJ were determined at different embryonic days (E) (E16, 18, 20 and postnatal day 1). The functional studies were performed by harvesting ureters from wild-type mice at embryonic day 16 (E16), which were grown in serum-free organ-culture; some cultures were supplemented with TGF-β (2 and 20 ng/ml) and/or with soluble TGFR, which blocks bioactivity. Organs were harvested after 6 days and the expression of CD31 and Ki67 were assessed using immunohistochemistry. The muscle content of the UVJ and ureter were analyzed by flowcytometry. RESULTS The TGF-β and TGFR positive cells were immune detected in embryonic ureters. The TGF-β expression was highest on E18 and decreased postnatally. Exogenous TGF-β decreased ureterovesical (UV) muscle differentiation and proliferation. The longitudinal muscle fibers were significantly less in TGF-β explants. The TGF-β also decreased the proportions of cells expressing α smooth muscle actin (α-SMA). Soluble TGFR blocked the effects of exogenous TGF-β. CONCLUSIONS In organ culture, exogenous TGF-β postpones the UV smooth muscle proliferation and affects the muscular structure. Whether the effects of TGF-β are direct or indirect, these form an in-vitro megaureter model. The finding that TGF-β is highest in embryonic ureters in vivo and decreased postnatally suggests that a pathological persistence might potentially explain the pathogenesis of primary megaureters.
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Prognostic factors and biomarkers of congenital obstructive nephropathy. Pediatr Nephrol 2016; 31:1411-20. [PMID: 26667236 DOI: 10.1007/s00467-015-3291-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 12/14/2022]
Abstract
Congenital obstructive nephropathy (CON) is the leading cause of chronic kidney disease (CKD) in children. Anomalies of the urinary tract are often associated with abnormal nephrogenesis, which is compounded by obstructive injury and by maternal risk factors associated with low birth weight. Currently available fetal and postnatal imaging and analytes of amniotic fluid, urine, or blood lack predictive value. For ureteropelvic junction obstruction, biomarkers are needed for optimal timing of pyeloplasty; for posterior urethral valves, biomarkers of long-term prognosis and CKD are needed. The initial nephron number may be a major determinant of progression of CKD, and most patients with CON who progress to renal failure reach this point in adulthood, presumably compounded by episodes of acute kidney injury. Biomarkers of tubular injury may be of particular value in predicting the need for surgical intervention or in tracking progression of CKD, and must be adjusted for patient age. Discovery of new biomarkers may depend on "unbiased" proteomics, whereby patterns of urinary peptide fragments from patients with CON are analyzed in comparison to controls. Most promising are the analysis of urinary exosomes (restricting biomarkers to relevant tubular cells) and quantitative magnetic resonance imaging techniques allowing precise determination of nephron number and tubular mass. The greatest need is for large prospective multicenter studies with centralized biomarker sample repositories to follow patients with CON from fetal life through adulthood.
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Alipour A, Mohammadjafari H, Rafiei A, Amjadi O. The Role of Urinary Biomarker Levels in Assessing the Presence and Severity of Ureteropelvic Junction Obstruction in Children: A Systematic Review and Meta-Analysis. JOURNAL OF PEDIATRICS REVIEW 2016. [DOI: 10.17795/jpr-7567] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Kose F, Turkyilmaz Z, Sonmez K, Karabulut R, Poyraz A, Gulbahar O, Aral A, Damar C, Kaya C, Can Basaklar A. The effect of alfuzosin on renal resistive index, urinary electrolytes and β2 microglobulin levels and TGF β-1 levels of kidney tissue in rats with unilateral ureteropelvic junction obstruction. Ren Fail 2016; 38:1283-90. [PMID: 27402370 DOI: 10.1080/0886022x.2016.1207049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In this study, it was aimed to determine the effects of alfuzosin on experimentally generated unilateral partial ureteropelvic junction obstruction (UPO) in rats. MATERIALS AND METHODS Thirty Long-Evans rats were randomly allocated into five groups. In control group (C), nothing was performed; in group Sham (S) only laparotomy was done; in Alfuzosin group (A) only alfuzosin was administered for two weeks (10 mg/kg/day p.o.) without any surgery; in UPO group, unilateral UP junction obstruction was produced; and in the Group UPT (ureteropelvic obstruction + treatment), alfuzosin was administered for two weeks (10 mg/kg/day p.o.) in addition to UPO production. Renal pelvic anteroposterior diameters were determined with ultrasonography (USG) and renal arterial resistivity indexes by color Doppler USG. Urine was collected both at the beginning and at the end of the experiment for 24 h in all the groups and at the end of the experiment, blood samples were obtained. Blood and urine electrolytes and TGF-β1, urine density, urine β2 microglobulin levels were determined. Renal tissue samples harvested from all of the rats were histopathologically evaluated. Results were determined using one-way ANOVA t-test; p < 0.05 was accepted as significant. RESULTS Urine density in the UPT group was lower with respect to UPO group and blood electrolytes were preserved as close to normal (p < 0.05). In the UPT group, urine TGF-β1 and blood TGF-β1, blood β2 microglobulin levels and histopathologic damage scores were lower compared to the UPO group (p < 0.05). CONCLUSION It is shown in this experimental unilateral partial UPO model that alfuzosin treatment prevents obstructive renal damage.
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Affiliation(s)
- Faik Kose
- a Faculty of Medicine, Department of Pediatric Surgery , Gazi University , Ankara , Turkey
| | - Zafer Turkyilmaz
- a Faculty of Medicine, Department of Pediatric Surgery , Gazi University , Ankara , Turkey
| | - Kaan Sonmez
- a Faculty of Medicine, Department of Pediatric Surgery , Gazi University , Ankara , Turkey
| | - Ramazan Karabulut
- a Faculty of Medicine, Department of Pediatric Surgery , Gazi University , Ankara , Turkey
| | - Aylar Poyraz
- b Faculty of Medicine, Department of Pathology , Gazi University , Ankara , Turkey
| | - Ozlem Gulbahar
- c Faculty of Medicine, Department of Biochemistry , Gazi University , Ankara , Turkey
| | - Arzu Aral
- d Faculty of Medicine, Department of Immunology , Gazi University , Ankara , Turkey
| | - Cagri Damar
- e Faculty of Medicine, Department of Pediatric Radiology , Gazi University , Ankara , Turkey
| | - Cem Kaya
- a Faculty of Medicine, Department of Pediatric Surgery , Gazi University , Ankara , Turkey
| | - Abdullah Can Basaklar
- a Faculty of Medicine, Department of Pediatric Surgery , Gazi University , Ankara , Turkey
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Froehlich JW, Kostel SA, Cho PS, Briscoe AC, Steen H, Vaezzadeh AR, Lee RS. Urinary Proteomics Yield Pathological Insights for Ureteropelvic Junction Obstruction. Mol Cell Proteomics 2016; 15:2607-15. [PMID: 27215552 DOI: 10.1074/mcp.m116.059386] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Indexed: 01/14/2023] Open
Abstract
Prenatal hydronephrosis is a common condition that may spontaneously resolve after birth. However, this condition can result in renal damage and requires surgical correction in a number of cases. Preventing renal damage is paramount, but existing diagnostic technology is invasive, exposes infants to radiation, is costly, and is often indeterminate. A better understanding of the pathophysiology of renal obstruction as reflected in the urinary proteome may provide new insights into the disease that could potentially alter the clinical management of hydronephrosis. We performed a quantitative proteomics study of urine that was surgically obtained from eight clinically significant, unilaterally obstructed infants versus eight healthy controls, with the goal of identifying quantitatively varying proteins and the biological networks associated with them. Notably, urine was obtained from both the obstructed kidney and the bladder. Over 1100 proteins were identified, and a total of 76 quantitatively varying proteins were identified. Proteins involved in oxidative stress, inflammation, and renal disease pathways showed the most significant abundance differences. This study gives a deeper understanding of the critical proteomic changes associated with renal obstruction and represents the deepest proteomic profile of renal obstruction to date.
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Affiliation(s)
- John W Froehlich
- From the ‡Department of Urology and the Urological Diseases Research Center, §Proteomics Center at Children's Hospital Boston, Boston, MA
| | - Stephen A Kostel
- From the ‡Department of Urology and the Urological Diseases Research Center, §Proteomics Center at Children's Hospital Boston, Boston, MA
| | - Patricia S Cho
- From the ‡Department of Urology and the Urological Diseases Research Center, §Proteomics Center at Children's Hospital Boston, Boston, MA
| | - Andrew C Briscoe
- From the ‡Department of Urology and the Urological Diseases Research Center, §Proteomics Center at Children's Hospital Boston, Boston, MA
| | - Hanno Steen
- §Proteomics Center at Children's Hospital Boston, Boston, MA ¶Department of Pathology, Children's Hospital Boston and Harvard Medical School, Boston, MA
| | - Ali R Vaezzadeh
- From the ‡Department of Urology and the Urological Diseases Research Center, §Proteomics Center at Children's Hospital Boston, Boston, MA
| | - Richard S Lee
- From the ‡Department of Urology and the Urological Diseases Research Center, §Proteomics Center at Children's Hospital Boston, Boston, MA
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Chevalier RL. Congenital urinary tract obstruction: the long view. Adv Chronic Kidney Dis 2015; 22:312-9. [PMID: 26088076 PMCID: PMC4475271 DOI: 10.1053/j.ackd.2015.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/09/2015] [Accepted: 01/18/2015] [Indexed: 11/11/2022]
Abstract
Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients.
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Seven A, Savran B, Koçak E, Tok S, Yüksel KB, Gözükara İ, Kabil Kucur S. Is there a correlation between maternal serum TGF-β1 levels and fetal hydronephrosis? J Matern Fetal Neonatal Med 2015; 29:1113-6. [DOI: 10.3109/14767058.2015.1036022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mohammadjafari H, Rafiei A, Kosaryan M, Yeganeh Y, Hosseinimehr SJ. Determination of the severity of ureteropelvic junction obstruction using urinary epidermal growth factor and kidney injury molecule 1 levels. Biomark Med 2014; 8:1199-206. [DOI: 10.2217/bmm.14.79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Aim: This study aimed to assess the urinary concentrations of epidermal growth factor (EGF) and kidney injury molecule 1 (KIM-1) in patients with hydronephrosis. Methods: Neonates with a history of prenatal hydronephrosis were enrolled in three groups. Group 1 included neonates with severe obstruction; group 2 included neonates with milder obstruction; and group 3 included neonates with normal findings on postnatal ultrasonography. Results: 59 neonates were enrolled. The EGF: Cr and KIM-1: Cr ratios were significantly higher in group 1 than in group 2 (p = 0.016 and 0.015, respectively). The cut-off values were measured as 16.855 (sensitivity 71%, specificity 77%) and 0.4765 (sensitivity 81%, specificity 71%) for EGF:Cr and KIM-1:Cr ratios, respectively. The values were significantly higher in group 1 than in group 2. Conclusions: Evaluation of the urinary KIM-1:Cr ratio may help identify neonates with severe obstructive hydronephrosis.
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Affiliation(s)
- Hamid Mohammadjafari
- Antimicrobial Resistant Nosocomial Infection Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Alireza Rafiei
- Molecular & Cell Biology Research Center, Hemoglubinopathy Institute, School of Medicine Mazndaran University of Medical Sciences Sari, Iran
| | - Mehrnoush Kosaryan
- Professor of Pediatrics, Thalassemia Research Center, Hemoglubinopathy Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Yalda Yeganeh
- Department of Pediatrics, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Seyed Jalal Hosseinimehr
- Department of Radiopharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran
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Papachristou F, Pavlaki A, Printza N. Urinary and serum biomarkers in ureteropelvic junction obstruction: a systematic review. Biomarkers 2014; 19:531-40. [DOI: 10.3109/1354750x.2014.943292] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Fotios Papachristou
- 1st Pediatric Department, Aristotle University, Hippokratio Hospital
ThessalonikiGreece
| | - Antigoni Pavlaki
- 1st Pediatric Department, Aristotle University, Hippokratio Hospital
ThessalonikiGreece
| | - Nikoleta Printza
- 1st Pediatric Department, Aristotle University, Hippokratio Hospital
ThessalonikiGreece
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Şekerci ÇA, İşbilen B, İşman F, Akbal C, Şimşek F, Tarcan T. Urinary NGF, TGF-β1, TIMP-2 and Bladder Wall Thickness Predict Neurourological Findings in Children with Myelodysplasia. J Urol 2014; 191:199-205. [DOI: 10.1016/j.juro.2013.08.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2013] [Indexed: 02/01/2023]
Affiliation(s)
- Çagri Akin Şekerci
- Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Banu İşbilen
- Department of Biochemistry, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Ferruh İşman
- Department of Biochemistry, Göztepe Training and Research Hospital, Istanbul, Turkey
| | - Cem Akbal
- Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ferruh Şimşek
- Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tufan Tarcan
- Department of Urology, Division of Pediatric Urology, Marmara University School of Medicine, Istanbul, Turkey
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Madsen MG, Nørregaard R, Palmfeldt J, Olsen LH, Frøkiær J, Jørgensen TM. Epidermal growth factor and monocyte chemotactic peptide-1: potential biomarkers of urinary tract obstruction in children with hydronephrosis. J Pediatr Urol 2013; 9:838-45. [PMID: 23228281 DOI: 10.1016/j.jpurol.2012.11.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 11/13/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Hydronephrosis is diagnosed in 0.5% of all newborns, and ureteropelvic junction obstruction (UPJO) is a common cause. The aim of this study was to test whether specific urinary cytokines can be used as UPJO biomarkers in children with hydronephrosis. MATERIALS AND METHODS Twenty-eight children referred for pyeloplasty due to UPJO and 13 controls were included in this prospective study. Kidney function was assessed and urine samples collected pre-, peri-, and post-operatively. Urine levels of epidermal growth factor (EGF), monocyte chemotactic peptide-1 (MCP-1), macrophage inflammatory protein-1α (MIP-1α), interferon-γ-inducible protein-10 (IP-10), and RANTES were measured simultaneously by using a bead-based multiplex sandwich immunoassay. RESULTS In hydronephrotic children, preoperative urine levels were significantly increased for EGF (median 7.4 [1.2-60.2] vs. median 4.0 [1.2-13.8] ng/mg creatinine) and MCP-1 (median 136.9 [47.7-545.5] vs. median 80.1 [28.8-149.9] pg/mg creatinine) compared to those of controls. Urine levels of EGF and MCP-1 were identical to controls at the postoperative 1-year follow-up exam. CONCLUSION Urine levels of EGF and MCP-1 were preoperatively increased and postoperatively normalized. This study demonstrates that urine-excreted kidney cytokines may be potential biomarkers of obstruction in children with hydronephrosis.
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Affiliation(s)
- Mia Gebauer Madsen
- Department of Urology, Pediatric Section, Aarhus University Hospital, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark; The Water and Salt Research Center, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Gawłowska-Marciniak A, Niedzielski JK. Evaluation of TGF-β1, CCL5/RANTES and sFas/Apo-1 urine concentration in children with ureteropelvic junction obstruction. Arch Med Sci 2013; 9:888-94. [PMID: 24273575 PMCID: PMC3832820 DOI: 10.5114/aoms.2013.36912] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Revised: 08/20/2012] [Accepted: 08/26/2012] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION The aim of this study was to evaluate changes in expression of soluble biomarkers tumor factor growth-β1 (TGF-β1), CCL5/RANTES, and sFas/Apo-1 in the urine of patients undergoing ureteropyeloplasty for ureteropelvic junction (UPJ) obstruction. These factors are connected with different processes ongoing in the obstructive uropathy. If their urine concentrations correlate with AP diameter of the renal pelvis and differential function of the affected kidney, they can be helpful in making a decision on corrective surgery. MATERIAL AND METHODS Creatinine, TGF-β1, CCL5/RANTES, and sFas/Apo-1 levels were measured in the urine from the bladder and renal pelvis of 45 patients undergoing ureteropyeloplasty and from bladders of 25 patients undergoing inguinal herniorrhaphy. RESULTS LEVELS OF EXAMINED BIOMARKERS WERE HIGHER IN THE RENAL PELVIS AND BLADDER OF CHILDREN WITH UPJ OBSTRUCTION AS COMPARED TO CONTROLS: TGF-β1 in older children and adolescents (p < 0.05), CCL5/RANTES in the youngest and older children (p < 0.05), and sFas/Apo-1 in all patients (p < 0.05). Twelve months after surgery their levels in the bladder decreased: TGF-β1 in younger and older children (p < 0.05), CCL5/RANTES in the youngest patients and adolescents (p < 0.05), and sFas/Apo-1 in the youngest and older children (p < 0.05). A significant decrease in the AP diameter of the renal pelvis post-operatively (32.09 mm vs. 18.72 mm) (p < 0.01) and significant improvement in renal function (36.94% vs. 42.76%) (p < 0.05) were observed in the examined group. CONCLUSIONS Mean TGF-β1, CCL5/RANTES, and sFas/Apo-1 urine levels are significantly increased in patients with UPJ and decreased 1 year after ureteropyeloplasty. Bladder concentrations of examined factors may be clinically useful markers of obstruction.
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Affiliation(s)
| | - Jerzy K. Niedzielski
- Department of Pediatric Surgery and Urology, University Children's Hospital No. 4, Medical University of Lodz, Poland
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Mandelia A, Bajpai M, Agarwala S, Gupta AK, Kumar R, Ali A. The role of urinary TGF-β₁, TNF-α, IL-6 and microalbuminuria for monitoring therapy in posterior urethral valves. Pediatr Nephrol 2013; 28:1991-2001. [PMID: 23748363 DOI: 10.1007/s00467-013-2506-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 04/15/2013] [Accepted: 04/15/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Long-term renal deterioration is common in patients with posterior urethral valves (PUV), and early identification of detrimental factors can help in counselling patients as well as in guiding future therapy. The aim of our study was (1) to evaluate urinary transforming growth factor-β1 (TGF-β1), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) levels and microalbuminuria before and after ablation of PUV and (2) to examine the effect of early induction of angiotensin-converting enzyme inhibitors (ACE-I) on renal recovery. METHODS The study included 30 patients with diagnosed PUV. Urinary cytokines were measured pre-operatively and post-operatively for 1 year. The study group was subdivided into two subgroups at 6 months after surgery. Group 1 included 16 patients whose urinary TGF-β1 level showed a declining trend. Group 2 included 14 patients whose urinary TGF-β1 showed a rising trend or plateaued; these patients were started on ACE-I therapy, which they received for at least 6 months. RESULTS Urinary TGF-β1, TNF-α and microalbumin levels were high in patients with PUV. In Group 1 patients, urinary TGF-β1, TNF-α and microalbumin levels fell significantly following valve ablation and continued to decline for 12 months. In Group 2 patients, after an initial fall following valve ablation, urinary TGF-β1, TNF-α and microalbumin showed a continued rise until 6 months post-surgery. After ACE-I therapy, there was 53.43 % fall in urinary TGF-β1, 43.15 % fall in microalbuminuria, 28.57 % improvement in split renal function and 35.80 % improvement in GFR. CONCLUSIONS Based on our results, urinary TGF-β1, urinary TNF-α and microalbuminuria can be used as biomarkers for the early recognition of ongoing renal damage in patients with PUV. ACE-I plays a role in retarding renal damage in these patients.
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Affiliation(s)
- Ankur Mandelia
- Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi 110029, India
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Interactions between cytokines, congenital anomalies of kidney and urinary tract and chronic kidney disease. Clin Dev Immunol 2013; 2013:597920. [PMID: 24066006 PMCID: PMC3770011 DOI: 10.1155/2013/597920] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Revised: 07/18/2013] [Accepted: 07/25/2013] [Indexed: 12/25/2022]
Abstract
Fetal hydronephrosis is the most common anomaly detected on antenatal ultrasound, affecting 1-5% of pregnancies. Postnatal investigation has the major aim in detecting infants with severe urinary tract obstruction and clinically significant urinary tract anomalies among the heterogeneous universe of patients. Congenital uropathies are frequent causes of pediatric chronic kidney disease (CKD). Imaging techniques clearly contribute to this purpose; however, sometimes, these exams are invasive, very expensive, and not sufficient to precisely define the best approach as well as the prognosis. Recently, biomarkers have become a focus of clinical research as potentially useful diagnostic tools in pediatric urological diseases. In this regard, recent studies suggest a role for cytokines and chemokines in the pathophysiology of CAKUT and for the progression to CKD. Some authors proposed that the evaluation of these inflammatory mediators might help the management of postnatal uropathies and the detection of patients with high risk to developed chronic kidney disease. Therefore, the aim of this paper is to revise general aspects of cytokines and the link between cytokines, CAKUT, and CKD by including experimental and clinical evidence.
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Prediction of the outcome of antenatal hydronephrosis: significance of urinary EGF. Pediatr Nephrol 2012; 27:2251-9. [PMID: 22773267 DOI: 10.1007/s00467-012-2243-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Down-regulation of epidermal growth factor (EGF) in the renal parenchyma has been demonstrated in children who underwent pyeloplasty due to ureteropelvic junction obstruction (UPJO). Urine levels of EGF were confirmed to parallel this finding before and after surgery. The aim of our study was to evaluate the relationship between urinary EGF (uEGF) concentrations and Society of Fetal Urology (SFU) high-grade hydronephrosis in infants presenting unilateral antenatal hydronephrosis (ANH). METHODS This was a prospective study involving 45 infants (33 in the observational group, 12 in the surgical group) who presented with unilateral ANH. Postnatal evaluation included a clinical examination, renal ultrasonography, and voiding cystourethrography. Diuretic renal scans were performed in infants with an initial SFU grade 3 or 4 hydronephrosis or increasing hydronephrosis during follow-up. Pyeloplasty was performed when a well-tempered renogram showed an obstructive drainage curve with a half-life of >20 min and/or an obstructive washout curve pattern during the diuretic phase. We studied the longitudinal changes in SFU hydronephrosis grade and uEGF in each group and compared concentration levels at three time points in both groups. The enzyme-linked immunosorbent assay (ELISA) method was used to measure EGF concentrations in the urine. The results were normalized with urinary creatinine (Cr). RESULTS During the first 6 months, from 6 to 12 months, and in the second year of life, median SFU hydronephrosis grade and uEGF levels were 2, 2 (p = 0.015), and 1 (p < 0.01), and 50, 59 (p = 0.015), and 69.5 ng/mg Cr (p < 0.01), respectively, in the observational group. In the first 6 months, preoperatively and at 3-12 months postoperatively, the median SFU hydronephrosis grade and uEGF levels were 4, 4, and 3 (p > 0.05), and 38, 46, (p > 0.05), and 55 ng/mg Cr (p < 0.01), respectively, in the surgical group. uEGF levels in the first 6 months of life were significantly lower in the surgical group than in the observational group (p < 0.01). Patients in the observational group with SFU grade 3-4 hydronephrosis showed higher uEGF levels than those in the surgical group with SFU grade 3-4 in (p = 0.048). CONCLUSIONS Urinary EGF changes over time are associated with inverse changes in SFU hydronephrosis grade, which suggests a role for uEGF as a predictive marker of worsening hydronephrosis grades in infants with ANH. uEGF in the first 6 months of life may predict the need for surgery in infants with ANH.
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Li ZZ, Zhao ZZ, Wen JG, Xing L, Zhang H, Zhang Y. Early alteration of urinary exosomal aquaporin 1 and transforming growth factor β1 after release of unilateral pelviureteral junction obstruction. J Pediatr Surg 2012; 47:1581-6. [PMID: 22901921 DOI: 10.1016/j.jpedsurg.2011.12.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 12/28/2011] [Accepted: 12/28/2011] [Indexed: 01/03/2023]
Abstract
BACKGROUND/PURPOSE Down-regulation of aquaporin 1 (AQP1) and up-regulation of transforming growth factor β(1) (TGF-β(1)) in the renal parenchyma have been demonstrated in children who underwent pyeloplasty for pelviureteral junction obstruction. However, no information about urinary exosomal AQP1 and TGF-β(1) during postobstructive polyuria in children with congenital unilateral hydronephrosis is available. The aim of the present study is to evaluate the urine concentration of exosomal AQP1 and TGF-β(1) on the first and the second day after surgery in children who underwent pyeloplasty. METHODS Twenty-two patients (age, 36.2 ± 17.1 months) with unilateral pelviureteral junction obstruction were examined in the study. For the first 2 days after the operation, the urine was collected separately from pyelostomy draining only from the postobstructed kidney and from the bladder catheter draining mostly from the contralateral kidney, which was used as an internal control. Urinary output, urinary osmolality, sodium, β(2)-microglobulin (β(2)-MG), and creatinine, as well as urinary exosomal AQP1 and TGF-β(1) excretion, were tested in each sample. RESULTS After pyeloplasty, a significantly decreased urinary excretion of exosomal AQP1 (≈ 64%) was found in the postobstructed kidney. The patients developed polyuria (807 ± 216 mL/24 h vs 484 ± 144 mL/24 h at day 1, 1021 ± 348 mL/24 h vs 603 ± 228 mL/24 h at day 2; P < .01) and reduced urine osmolality (115 ± 44 mOsm/kg vs 282 ± 61 mOsm/kg at day 1, 139 ± 39 vs 303 ± 46 mOsm/kg at day 2; P < .01) that persisted for 48 hours. In parallel, urinary TGF-β(1) and β(2)-MG (normalized for creatinine) from the postobstructed kidney were significantly higher compared with the contralateral kidney. The urine output and urinary sodium concentration from the postobstructed kidney elevated significantly on the second day after the release of obstruction compared with those on the first day. The contralateral kidney also showed same trends. CONCLUSIONS The down-regulation of urinary exosomal AQP1 in the postobstructed kidney may account for the polyuria, hypotonic urine, and elevated urinary β(2)-MG. The urinary TGF-β(1) level locally increased in the postobstructed kidney may be involved in renal AQP1 down-regulation.
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Affiliation(s)
- Zhen Zhen Li
- The Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Henan 450052, China.
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Li Z, Liu X, Liu S, Gu C, Tian F, Wen J. Urinary heme oxygenase-1 in children with congenital hydronephrosis due to ureteropelvic junction obstruction. Biomarkers 2012; 17:471-6. [DOI: 10.3109/1354750x.2012.689009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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ZIEG JAKUB, BLAHOVA KVETA, SEEMAN TOMAS, BRONSKY JIRI, DVORAKOVA HANA, PECHOVA MARTA, JANDA JAN, MATOUSOVIC KAREL. Urinary transforming growth factor-β1 in children with obstructive uropathy. Nephrology (Carlton) 2011; 16:595-8. [DOI: 10.1111/j.1440-1797.2011.01459.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Shokeir AA. Role of urinary biomarkers in the diagnosis of congenital upper urinary tract obstruction. Indian J Urol 2011; 24:313-9. [PMID: 19468460 PMCID: PMC2684346 DOI: 10.4103/0970-1591.42611] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Congenital obstructive uropathy constitutes a significant cause of morbidity in children. Currently, there is no reference standard for the diagnosis of renal obstruction in children. The noninvasive measurement of biomarkers in voided urine has considerable appeal as a potential application in children with congenital obstructive nephropathy. The aim of the present review is to explore the current role of biomarkers in the diagnosis and follow-up of obstructive uropathy in children. Materials and Methods: The literature database (PubMed) was searched from inception to May 2007 regarding the role of urinary biomarkers in the diagnosis and follow-up of children with congenital obstructive uropathy. Results: The review included 23 experimental and 33 prospective controlled clinical studies. Several cytokines, peptides, enzymes and microproteins were identified as major contributors to or ensuing from obstruction-induced renal fibrosis and apoptosis. The most important biomarkers were transforming growth factor-β1 (TGFβ1), epidermal growth factor (EGF), endothelin-1 (ET-1), urinary tubular enzymes [N-acetyl-β-D-glucosaminidase (NAG), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP)], and microproteins [β2-microglobulin (β2M), microalbumin (M. Alb) and micrototal protein (M.TP)]. All biomarkers showed different degrees of success but the most promising markers were TGFβ1, ET-1 and a panel of tubular enzymes. These biomarkers showed sensitivity of 74.3% to 100%, specificity of 80% to 90% and overall accuracy of 81.5% to 94% in the diagnosis of congenital obstructive uropathy in children. Moreover, some of the markers were valuable in differentiation between dilated non-obstructed kidneys in need of conservative management and obstructed kidneys in need of surgical correction. Some studies demonstrated that urinary biomarkers are helpful in the evaluation of success of treatment of children with congenital renal obstruction. Some limitations of the previous studies include lack of different types of controls and small sample size. Larger studies with variable controls are invited to confirm the clinical usefulness of biomarkers in the diagnosis and follow-up of children with congenital obstructive uropathy. Conclusion: Urinary biomarkers are a promising tool that could be used as a noninvasive assessment of congenital renal obstruction in children.
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Klein J, Gonzalez J, Miravete M, Caubet C, Chaaya R, Decramer S, Bandin F, Bascands JL, Buffin-Meyer B, Schanstra JP. Congenital ureteropelvic junction obstruction: human disease and animal models. Int J Exp Pathol 2011; 92:168-92. [PMID: 20681980 PMCID: PMC3101490 DOI: 10.1111/j.1365-2613.2010.00727.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 06/03/2010] [Indexed: 02/06/2023] Open
Abstract
Ureteropelvic junction (UPJ) obstruction is the most frequently observed cause of obstructive nephropathy in children. Neonatal and foetal animal models have been developed that mimic closely what is observed in human disease. The purpose of this review is to discuss how obstructive nephropathy alters kidney histology and function and describe the molecular mechanisms involved in the progression of the lesions, including inflammation, proliferation/apoptosis, renin-angiotensin system activation and fibrosis, based on both human and animal data. Also we propose that during obstructive nephropathy, hydrodynamic modifications are early inducers of the tubular lesions, which are potentially at the origin of the pathology. Finally, an important observation in animal models is that relief of obstruction during kidney development has important effects on renal function later in adult life. A major short-coming is the absence of data on the impact of UPJ obstruction on long-term adult renal function to elucidate whether these animal data are also valid in humans.
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Affiliation(s)
- Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Julien Gonzalez
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Mathieu Miravete
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Cécile Caubet
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Rana Chaaya
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Stéphane Decramer
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
- Department of Pediatric Nephrology, Hôpital des Enfants, Centre de Référence du Sud Ouest des Maladies Rénales RaresToulouse, France
| | - Flavio Bandin
- Department of Pediatric Nephrology, Hôpital des Enfants, Centre de Référence du Sud Ouest des Maladies Rénales RaresToulouse, France
| | - Jean-Loup Bascands
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Bénédicte Buffin-Meyer
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
| | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM)Toulouse, France
- Université Toulouse III Paul-Sabatier, Institut de Médecine Moléculaire de RangueilToulouse, France
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Urinary levels of TGF β-1 and of cytokines in patients with prenatally detected nephrouropathies. Pediatr Nephrol 2011; 26:739-47. [PMID: 21331646 DOI: 10.1007/s00467-011-1802-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2010] [Revised: 12/29/2010] [Accepted: 01/25/2011] [Indexed: 12/18/2022]
Abstract
This study aimed to identify noninvasive biomarkers of clinically significant nephrouropathies in patients with antenatal renal and/or urinary tract alterations. Spot-urine levels of interleukin-6 (IL-6), transforming growth factor-β1 (TGF-β1) and tumor necrosis factor-α (TNF-α) were measured in 100 patients with antenatal detected nephrouropathies. Patients were divided in idiopathic hydronephrosis (n = 47), urinary tract malformations (n = 35), and dysplastic kidneys (n = 18). Urinary concentrations of TGF-β1, IL-6, and TNF-α were compared between groups according to clinical and image findings. Receiver-operating characteristic (ROC) curves were analyzed for the overall diagnostic accuracy of TGF-β1, IL-6, and TNF-α levels in discriminating infants with nephrouropathies. No significant differences in urinary TGF- β1, IL-6, and TNF-α levels were found in the comparison between the groups. TGF-β1 levels tended to be higher in patients with renal hypodysplasia compared to idiopathic hydronephrosis (p = 0.07). Twenty-nine patients had reduced DMSA uptake. In these cases, absolute urinary concentration of TGF-β1 and levels standardized for creatinine were significantly higher than in patients with normal DMSA uptake, while IL6 and TNF-α did not differ between groups. Urinary cytokine measurements were not useful as a screening test for clinically significant nephrouropathies. Conversely, increased concentrations of TGF-β1 pointed out to renal damage as indicated by reduced DMSA uptake.
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Madsen MG, Nørregaard R, Frøkiær J, Jørgensen TM. Urinary biomarkers in prenatally diagnosed unilateral hydronephrosis. J Pediatr Urol 2011; 7:105-12. [PMID: 21220211 DOI: 10.1016/j.jpurol.2010.12.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2010] [Accepted: 12/02/2010] [Indexed: 01/03/2023]
Abstract
The introduction of prenatal ultrasonography as a screening method entails an increasing number of infants diagnosed with prenatal hydronephrosis. Ureteropelvic junction obstruction accounts for 35% of prenatal hydronephrotic cases. Urinary tract obstruction that occurs during early kidney development affects renal morphogenesis, maturation and growth, and in the most severe cases this will ultimately cause renal insufficiency. A major challenge in the clinical management of these patients is to preserve renal function by selection of the 15%-20% who require early surgical intervention, leaving those for whom watchful waiting may be appropriate because of spontaneous resolution/stabilization without significant loss of renal function. Today, this requires medical surveillance, including repetitive invasive diuretic renograms relying on arbitrary threshold values, and therefore there is a need for non-arbitrary, non-invasive urinary biomarkers that may be used as predictors for renal structural changes and/or decreasing renal function, and thereby provide the surgeon with more clear indications for surgical intervention. In this review, we summarize the currently well-known facts about urinary biomarkers in ureteropelvic junction obstruction concerning renal function, and we also suggest potential novel urinary biomarkers.
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Affiliation(s)
- Mia Gebauer Madsen
- Institute of Clinical Medicine, Aarhus University, Brendstrupgaardsvej 100, 8200 Aarhus N, Denmark.
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Bartoli F, Penza R, Aceto G, Niglio F, D'Addato O, Pastore V, Campanella V, Magaldi S, Lasalandra C, Di Bitonto G, Gesualdo L. Urinary epidermal growth factor, monocyte chemotactic protein-1, and β2-microglobulin in children with ureteropelvic junction obstruction. J Pediatr Surg 2011; 46:530-6. [PMID: 21376205 DOI: 10.1016/j.jpedsurg.2010.07.057] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 07/05/2010] [Accepted: 07/31/2010] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE We demonstrated down-regulation of epidermal growth factor (EGF) and up-regulation of monocyte chemotactic protein-1 (MCP-1) in the renal parenchyma in children who underwent pyeloplasty for ureteropelvic junction obstruction (UPJO). These findings were paralleled by urinary levels of EGF and MCP-1 before and after surgery. The aim of this study is to evaluate the urinary excretion of these cytokines and β2-microglobulin (β2M) in children with urine flow impairment at the ureteropelvic junction or who underwent pyeloplasty. METHODS Seventy-six patients with UPJO and 30 normal children (CTRL) were enrolled in the study. The UPJO patients were divided into obstructive (12), functional (36), and operated (28). Epidermal growth factor, MCP-1, and β2M urinary levels were measured by enzyme-linked immunosorbent assay and normalized to urine creatinine. RESULTS Urinary β2M and MCP-1 increased significantly in the UPJO groups compared with the CTRL and significantly improved in the operated group. The obstructive group displayed reduced EGF excretion compared with the CTRL group. The urinary (u)EGF/uMCP-1, and uEGF/uβ2M ratios significantly decreased in both untreated groups. In the operated group, these ratios improved significantly. CONCLUSIONS The present study substantiates the role of urinary EGF, MCP-1, and β2M as markers of tubulointerstitial damage in human obstructive nephropathy. Furthermore, it suggests that surgical intervention is effective in the management of children with UPJO.
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Affiliation(s)
- Fabio Bartoli
- Division of Pediatric Surgery, University of Foggia, Foggia, Italy.
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Sager C, Lopez JC, Duran V, Burek C, Perazzo E. Transforming growth factor-beta1 in congenital ureteropelvic junction obstruction: diagnosis and follow-up. Int Braz J Urol 2010; 35:315-23; discussion 323-5. [PMID: 19538767 DOI: 10.1590/s1677-55382009000300008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2009] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the role of transforming growth factor-beta1 (TGF-beta1) in congenital ureteropelvic junction obstruction at diagnosis and during postoperative follow-up. MATERIALS AND METHODS We conducted a case-control study including 19 patients with a mean age of 6.7 years and 19 matched controls. All patients presented negative voiding cystourethrography, obstructive diuretic renogram and underwent dismembered pyeloplasty. Urinary TGF-beta1 and other markers were measured pre-, intra- and postoperatively. RESULTS The mean bladder urine TGF-beta1 concentration in obstructed patients prior to pyeloplasty was higher than in controls (92.5 pg/mL +/- 16.8 vs. 35.8 pg/mL +/- 16.2; p = 0.0001). The mean renal pelvic urine TGF-beta1 concentration in the hydronephrotic kidney was higher than in the preoperative bladder urine sample (122.3 pg/mL +/- 43.9 vs. 92.5 pg/mL +/- 16.8; p = 0.036). Postoperative mean TGF-beta1 concentration was significantly lower than preoperative TGF-beta1 (48.7 pg/mL +/- 13.1 vs. 92.5 pg/mL +/- 16.8; p = 0.0001). CONCLUSION TGF-beta1 is a cytokine leading to renal fibrosis. The measurement of urinary TGF-beta1 could become a useful tool for the diagnosis of obstructive hydronephrosis and the evaluation of the parenchyma function status, pre and postoperatively.
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Affiliation(s)
- Cristian Sager
- Urology Department, Hospital de Pediatria Dr J P Garrahan, Buenos Aires, Argentina.
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Drube J, Zürbig P, Schiffer E, Lau E, Ure B, Glüer S, Kirschstein M, Pape L, Decramer S, Bascands JL, Schanstra JP, Mischak H, Ehrich JHH. Urinary proteome analysis identifies infants but not older children requiring pyeloplasty. Pediatr Nephrol 2010; 25:1673-8. [PMID: 20180135 DOI: 10.1007/s00467-010-1455-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Revised: 12/23/2009] [Accepted: 01/07/2010] [Indexed: 11/30/2022]
Abstract
One out of every five children suffering from ureteropelvic junction obstruction (UPJO) requires pyeloplasty. This prevalence indicates an urgent necessity to identify high-grade UPJO as early as possible to avoid renal damage. A novel non-invasive proteomic urine test has recently been introduced that is able to detect these patients at an early stage. In the study reported here, we tested this approach to assess its use in our centre and to expand its application to older children. Twenty-seven children (median age 0.4 years, range 0.1-8.8 years) with hydronephrosis who had been scheduled a nuclear diuretic renal scan (DR) to identify urodynamically relevant UPJO were included in our prospective study. Patients with prior surgery of the urinary tract were excluded. The urinary proteome pattern was analysed using capillary electrophoresis coupled to mass spectrometry. Of the 27 children, 11 had a relevant UPJO diagnosed by the DR. In 19 children <1 year of age, urinary proteome analysis predicted obstruction with a sensitivity of 83% (5/6) and a specificity of 92% (12/13). However, in older patients, the sensitivity decreased to 20% (1/5) and specificity to 66% (2/3). Based on our results, the proteome pattern established by Decramer and co-workers predicts the need for surgery in infants but not in older children with UPJO.
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Affiliation(s)
- Jens Drube
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany.
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Ucero AC, Gonçalves S, Benito-Martin A, Santamaría B, Ramos AM, Berzal S, Ruiz-Ortega M, Egido J, Ortiz A. Obstructive renal injury: from fluid mechanics to molecular cell biology. Res Rep Urol 2010; 2:41-55. [PMID: 24198613 PMCID: PMC3818880 DOI: 10.2147/rru.s6597] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Urinary tract obstruction is a frequent cause of renal impairment. The physiopathology of obstructive nephropathy has long been viewed as a mere mechanical problem. However, recent advances in cell and systems biology have disclosed a complex physiopathology involving a high number of molecular mediators of injury that lead to cellular processes of apoptotic cell death, cell injury leading to inflammation and resultant fibrosis. Functional studies in animal models of ureteral obstruction using a variety of techniques that include genetically modified animals have disclosed an important role for the renin-angiotensin system, transforming growth factor-β1 (TGF-β1) and other mediators of inflammation in this process. In addition, high throughput techniques such as proteomics and transcriptomics have identified potential biomarkers that may guide clinical decision-making.
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Affiliation(s)
- Alvaro C Ucero
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Fundación Renal Iñigo Alvarez de Toledo, Madrid, Spain
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Almodhen F, Loutochin O, Capolicchio JP, Jednak R, El-Sherbiny M. The Role of Bladder Urine Transforming Growth Factor-β1 Concentrations in Diagnosis and Management of Unilateral Prenatal Hydronephrosis. J Urol 2009; 182:292-8; discussion 298. [DOI: 10.1016/j.juro.2009.02.132] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Indexed: 11/25/2022]
Affiliation(s)
- Fayez Almodhen
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Oleg Loutochin
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - John Paul Capolicchio
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Roman Jednak
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Mohamed El-Sherbiny
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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Decramer S, Bascands JL, Schanstra JP. Non-invasive markers of ureteropelvic junction obstruction. World J Urol 2007; 25:457-65. [PMID: 17701042 DOI: 10.1007/s00345-007-0201-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2007] [Accepted: 07/09/2007] [Indexed: 01/08/2023] Open
Abstract
Non-invasive prognosis of the clinical progression of disease is of high interest, especially in newborn and children. Neonatal ureteropelvic (UPJ) junction obstruction needs close and invasive surveillance to determine the necessity of pyeloplasty. A number of groups have initiated research with the aim to find non-invasive biomarkers for UPJ obstruction. Two different strategies have been followed. One strategy, based on the knowledge obtained in animal models of UPJ obstruction, has identified a number of individual urinary markers of severe UPJ obstruction. Combining these markers might allow prediction of which patients will require surgery and in which patients UPJ obstruction will spontaneously resolve. The other strategy is based on urinary proteomics. In this strategy the entire urinary proteome is probed for a set of biomarkers that correlates with the degree of UPJ obstruction. In subsequent steps, these sets of urinary biomarkers are used for prediction of the clinical evolution of UPJ obstruction patients. This proteomic-based strategy allowed prediction, several months in advance, of the clinical evolution of neonates with UPJ-obstruction. Both strategies will be complementary and will hopefully replace in the near future the invasive follow-up of newborns with UPJ obstruction.
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Affiliation(s)
- Stephane Decramer
- INSERM, U858/I2MR, Team 5 Renal and Cardiac Remodeling, 1 Avenue Jean Poulhès, BP 84225, 31432 Toulouse Cedex 4, France
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