ESPN 50th Annual Meeting

ESPN 2017


 
Assessment markers of sclerosis and collagenopathy in the diagnosis of reflux nephropathy in children with vesicoureteral reflux
NATALIA ZAICOVA VLADIMIAR DLIN 1 ANATOLII KORSUNSCHII 2 NELLI REVENCO 3

1- N.I. PIROGOV RUSSIAN NATIONAL RESEARCH MEDICAL UNIVERSITY MOSCOW
2- DEPARTMENT OF PEDIATRICS AND COMMUNICABLE DISEASES, I.M. SECHENOV FIRST MOSCOW STATE MEDICAL UNIVERSITY MOSCOW, RUSSIA
3- INSTITUTION OF MOTHER AND CHILD CARE, KISHINEV, MOLDOVA
 
Introduction:

To reveal the informative indicators for the diagnosis of reflux nephropathy (RN) in children with vesicoureteral reflux (VUR) based on the study of the urinary excretion of transforming growth factor (TGF-β1), angiotensin II (Ang II) and markers of collagenopathy (peptide-bound hydroxyproline (PBH) and free hydroxyproline (FH))

Material and methods:

The study group included 71 children with varying degrees of VUR in age from 1 year to 14 years (average age of 5.89±0.45 years), including 52 girls (73.2 %, χ²=6.72, p<0.05). All children were divided according to the results of DMSA-scan into 3 groups depending on the degree of renal scars and reflux nephropathy (RN): 9 p. with VUR without renal scars, 17 p. with mild RN (scars 1-3) and 45 p. with severe RN (> 3 scars). 20  healthy children served as controls, aged 6.24 ± 0.31 y. Urinary excretion and ratios over creatinine of TGF-β1 and Ang II were examined by ELISA.

The level of free and peptide-bound hydroxyproline in the urine was determined by the method of estimation of the density of the red Chromogen, resulting from the oxidation and decarboxylation of hydroxyproline molecules and condensation of oxidation product with paradimethylaminobenzaldehyde.

Results:

The level of urinary excretion of AngII and TGF-β1, PBH and FH was significantly higher in all patients with VUR compared to the healthy children. The patients with III-IV degree of RN to have increased urinary excretion  of AngII and TGF-β1, PBH and the level  was significantly higher than in children with I-II degree of RN (p<0.05), confirming their association with the severity of sclerotic processes in the tubulointersticial tissues. There was a strong direct correlation between the level of excretion of Ang II, PBH, TGF-β1 and the degree of reflux nephropathy (r=0.64, p<0.05) and a moderate inverse correlation between the FH and the degree of reflux nephropathy (r=-0.57, p<0.05).

Conclusions:

Established correlation between urinary excretion of AngII and TGF-β1, PBH and FH and the severity of tubulointerstitial damage in children with VUR, evidence of their potential use as diagnostic markers of nephrosclerosis and dynamic observation of patients with vesicoureteral reflux.