Pelvi‐ureteric junction obstruction in children: the role of urinary transforming growth factor‐β₁ and epidermal growth factor

Abstract

In this section authors from Egypt describe the use of urinary TGFβ1 and epidermal growth factor in PUJ obstruction. In another paper, authors from London herald what they consider to be a new era in the management of end‐stage renal disease in children, presenting the technique of bilateral synchronous posterior prone retroperitoneoscopic nephrectomy with simultaneous peritoneal dialysis. OBJECTIVES To investigate the role of transforming growth factor β1 (TGF‐β1) and epidermal growth factor (EGF) in voided urine for the diagnosis and follow‐up of children with pelvi‐ureteric junction obstruction (PUJO). PATIENTS, SUBJECTS AND METHODS The study included 35 children with unilateral PUJO who had a pyeloplasty, and 30 healthy control children. Urine samples were obtained from the bladders of patients before surgery, and as voided samples at 1, 2, 3, 6, 9 and 12 months after surgery. Bladder urine samples were also collected from all 30 children in the control group. TGF‐β1 and EGF were then measured in all the urine samples. RESULTS The level of bladder TGF‐β1 before surgery in the patients was significantly higher than that in the healthy control group. A threshold of 190 pg/mg creatinine gave a sensitivity of 100%, a specificity of 80%, a positive predictive value of 85.4%, negative predictive value of 100% and an overall accuracy of 90.8%. Compared with the value before surgery, urinary TGF‐β1 was significantly lower at 1 year after pyeloplasty. There was no significant difference between the level of EGF before surgery in the patients and that in the control group, and no significant difference in the level of EGF before and after surgery over the follow‐up. CONCLUSION We do not recommend using EGF levels in voided urine in the routine diagnosis of children with hydronephrosis. The urinary level of TGF‐β1 is a useful noninvasive tool for the long‐term follow‐up of children with PUJO treated by pyeloplasty. Further studies with various controls are required to confirm the diagnostic accuracy of TGF‐β1 in children with PUJO.

Urinary Proteomics Yield Pathological Insights for Ureteropelvic Junction Obstruction

“…Elevated proteins included angiotensin; albumin; keratin 8; keratin 9; lectin, galactoside-binding, sol- uble, 3 binding protein; macrophage inhibitory factor; myosin heavy chain 7; serpin peptidase inhibitor; clade A member 1; and transferrin. Epidermal growth factor was previously reported as down-regulated (14), and our study replicated that trend although statistical significance was not achieved in this study cohort. Similarly, prior studies evaluating BU also shared trends with KU quantitation.…”

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

“…18,19 Biochemical indicators such as TGF-b 1 and b 2 microglobulin, urine, and blood electrolytes are also utilized in diagnosing and monitoring UPO in the recent years. [20][21][22][23][24][25] Alfuzosin, one of the selective a 1 blockers, is a pharmacological agent used in prostate hypertrophy. Thanks to its ability to inhibit smooth muscle contractions, it has been utilized recently for ensuring smooth passage of ureteral calculi.…”

Obstructive renal injury: from fluid mechanics to molecular cell biology

“…167 However increased TGF-β1 is not specific for UTO as it can also be found on other renal diseases.…”

“…162,163,173,174 However, subsequent studies did not confirm decreased urinary EGF in subjects with UTO, thus reducing its biomarker potential. 167,176 Urinary tubular enzymes, such as N-acetyl-beta-Dglucosaminidase (NAG), gamma-glutamyl transferase (GGT) and alkaline phosphatase (AP) have been evaluated for diagnostic and prognostic value in clinical UTO. [177][178][179] The combination of NAG and AP was reported to have a sensitivity of 100%, a specificity of 80% and an overall accuracy of 94% for differentiating between children with ureteropelvic junction obstruction requiring pyeloplasty and those with dilated nonobstructed kidneys suitable for conservative treatment (Table 2).…”

“…TGF-β1 is increased in kidney tissue, 162 in the stenotic ureter 163 and in urine [164][165][166][167] from children with UPJ obstruction, allowing the diagnosis with good accuracy values (for a threshold of 190 pg/mg creatinine) for UPJ obstruction requiring surgery (Table 2). 167 However increased TGF-β1 is not specific for UTO as it can also be found on other renal diseases.…”