The Role of Bladder Urine Transforming Growth Factor-β1 Concentrations in Diagnosis and Management of Unilateral Prenatal Hydronephrosis

Abstract

Bladder urine transforming growth factor-beta1 changes through time are associated with similar changes in hydronephrosis grade. Bladder urine transforming growth factor-beta1 in the first 3 months of life can predict the need for surgery in newborns with prenatal hydronephrosis.

Canadian Urological Association/Pediatric Urologists of Canada guidelines on the investigation and management of antenatally detected hydronephrosis

“…This type of abnormal anatomy is often found in children with the VACTERL association or cloacal anomalies. Non-invasive studies such urinary biomarkers such as transforming growth factor beta are still under investigation, but hold promise in predicting those cases who would deteriorate and require closer follow-up (37). Similarly, the field of functional renography holds promise both with nuclear medicine (38) and positron emission tomography (39).…”

Urinary levels of TGF β-1 and of cytokines in patients with prenatally detected nephrouropathies

“…Biomarkers are potentially useful diagnostic tools, which have recently become a focus of clinical research [9][10][11][12][13]. Regarding the pediatric nephrourology setting, there have been various attempts to identify noninvasive diagnostic markers of congenital renal obstruction and vesicoureteral reflux (VUR) [14][15][16].…”

“…Galanakis et al [18] have found elevated urinary IL-8 concentration in infants with VUR. Recently, Almodhen et al [9], observed that a cutoff of 17 pg/mmol creatinine for bladder TGF-β1 levels collected in the first 3 months of life had a good diagnostic accuracy in predicting surgery in patients with unilateral prenatal hydronephrosis. Drecramer and co-workers [19] and, more recently, Drube et al [20] have shown that novel non-invasive proteomic urine tests predict with high accuracy the need for surgery in infants with ureteropelvic junction obstruction (UPJO).…”

Avaliação dos valores séricos e urinários de CA 19-9 e TGFbeta1 na obstrução parcial e completa de ureteres em ratos

“…Em estudos clínicos, também se observou a correlação positiva dos níveis do TGF ß1 com uropatia obstrutiva, com aumento dos níveis urinários de TGF ß1 em crianças com estenose da junção ureteropiélica submetidas à pieloplastia (Palmer et al, 1997;Furness et al, 1999;El-Sherbiny et al, 2002;Sager et al, 2009;Almodhen et al, 2009). …”

“…Ratos transgênicos adultos Klotho, que são portadores de proteína Klotho, submetidos à UUO, tiveram supressão dos efeitos do TGF ß1, incluindo diminuição da transição epitelial-mesenquimal, diminuição da resposta inflamatória associada à obstrução e da subsequente fibrose renal. Houve inibição da fosforilação da Smad2 (Doi et al, 2011 Além disso, reforçou-se a idéia de que o TGF ß1 urinário é uma ferramenta não invasiva útil após a pieloplastia (Almodhen et al, 2009). …”