Olga Morozova1, Dmitry Morozov2, Dmitri Pervouchine3, Yulia Einav4, Darya Lakomova5, Natalya Zakharova6, Lubov Severgina7, Larisa Maltseva1, Ivan Budnik8. 1. Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. 2. Department of Pediatric Surgery, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. 3. Center for Data-Intensive Biomedicine and Biotechnology, Skolkovo Institute of Science and Technology, Moscow, Russia. 4. Holon Institute of Technology, Holon, Israel. 5. Department of Pediatric Surgery, Saratov State Medical University n. a. V. I. Razumovsky, Saratov, Russia. 6. Research Institute for Fundamental and Clinical Uronephrology, Saratov State Medical University n. a. V. I. Razumovsky, Saratov, Russia. 7. Department of Pathological Anatomy, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. 8. Department of Pathophysiology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia. budnik.ivan@gmail.com.
Abstract
PURPOSE: To investigate the urinary levels of TGF-β1, VEGF, and MCP-1 as potential biomarkers of latent inflammation and fibrosis in the kidney before and 6 months after correction of vesicoureteral reflux (VUR) in children. METHODS: A total of 88 patients (mean age 26 months) with VUR were divided into three groups: group A-patients with grades II-III VUR, conservative treatment; group B-patients with grades III-V VUR, endoscopic correction of VUR; group C-patients with grades III-V VUR, ureteral reimplantation after failed endoscopic correction. Control group included 20 healthy children. Biomarker levels were measured by ELISA. 99mTc-DMSA scintigraphy and renal histology were performed if possible. RESULTS: At admission, TGF-β1 was close to control in all study groups, VEGF increased with severity of the disease, and MCP-1 increased in group C. Six months after correction of VUR, despite clinical and laboratory improvement, TGF-β1 and MCP-1 increased while VEGF decreased compared to the admission values in all groups; no amelioration of renal scarring was detected either by 99mTc-DMSA scintigraphy or renal histology. CONCLUSION: The results support our hypothesis that successful correction of VUR is not sufficient to stop or reduce the latent inflammatory and fibrotic processes that have already started in the kidney regardless of the reflux grade and treatment option. Measuring the urinary levels of TGF-β1, VEGF, and MCP-1 may aid in the development of non-invasive, pathophysiologically relevant approach to diagnosis and monitoring of kidney injury and fibrosis in children with VUR.
PURPOSE: To investigate the urinary levels of TGF-β1, VEGF, and MCP-1 as potential biomarkers of latent inflammation and fibrosis in the kidney before and 6 months after correction of vesicoureteral reflux (VUR) in children. METHODS: A total of 88 patients (mean age 26 months) with VUR were divided into three groups: group A-patients with grades II-III VUR, conservative treatment; group B-patients with grades III-V VUR, endoscopic correction of VUR; group C-patients with grades III-V VUR, ureteral reimplantation after failed endoscopic correction. Control group included 20 healthy children. Biomarker levels were measured by ELISA. 99mTc-DMSA scintigraphy and renal histology were performed if possible. RESULTS: At admission, TGF-β1 was close to control in all study groups, VEGF increased with severity of the disease, and MCP-1 increased in group C. Six months after correction of VUR, despite clinical and laboratory improvement, TGF-β1 and MCP-1 increased while VEGF decreased compared to the admission values in all groups; no amelioration of renal scarring was detected either by 99mTc-DMSA scintigraphy or renal histology. CONCLUSION: The results support our hypothesis that successful correction of VUR is not sufficient to stop or reduce the latent inflammatory and fibrotic processes that have already started in the kidney regardless of the reflux grade and treatment option. Measuring the urinary levels of TGF-β1, VEGF, and MCP-1 may aid in the development of non-invasive, pathophysiologically relevant approach to diagnosis and monitoring of kidney injury and fibrosis in children with VUR.
Authors: Young Rim Song; Sun Jin You; Yun-Mi Lee; Ho Joon Chin; Dong-Wan Chae; Yun Kyu Oh; Kwon Wook Joo; Jin Suk Han; Ki Young Na Journal: Nephrol Dial Transplant Date: 2009-09-08 Impact factor: 5.992