First-year profile of biomarkers for early detection of renal injury in infants with congenital urinary tract obstruction

Author(s):Show less -

Kostic, Dusan ^[1] ; Neves dos Santos Beozzo, Glenda Priscila ^[2] ; do Couto, Saulo Brasil ^[1] ; Teruaki Kato, Andre Henrique ^[1] ; Lima, Laila ^[3] ; Palmeira, Patricia ^[3] ; Jornada Krebs, Vera Lucia ^[2] ; Bunduki, Victor ^[4] ; Vieira Francisco, Rossana Pulcineli ^[4] ; Zugaib, Marcelo ^[4] ; de Carvalho, Werther Brunow ^[2] ; Kalika Koch, Vera Hermina ^[1]

Affiliation

^[1] Univ Sao Paulo, Pediat Nephml Unit, Dept Pediat, Inst Crianca, Hosp Clin, Fac Med, Av Dr Eneas Carvalho De Aguiar 647, BR-05403000 Sao Paulo, SP - Brazil

^[2] Univ Sao Paulo, Dept Pediat, Inst Crianca, Hosp Clin, Fac Med, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Lab Clin Invest LIM 36, Inst Crianca, Hosp Clin, Fac Med, Sao Paulo - Brazil

^[4] Univ Sao Paulo, Dept Obstet & Gynecol, Hosp Clin, Fac Med, Sao Paulo - Brazil

• Document type: Journal article
• Source: Pediatric Nephrology; v. 34, n. 6, p. 1117-1128, JUN 2019.
• Web of Science Citations: 0

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-beta 1), retinol-binding protein (RBP), cystatin C (mu CyC), and microalbuminuria (ALB) 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-beta 1 (p<0.001), and mu ALB (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-beta 1 or KIM-1 and NGAL with CyC ({[}AUC] <= 0.934; sensitivity <= 92.4%; specificity <= 92.8%). Conclusions RBP, NGAL, KIM-1, TGF-beta 1, 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. (AU)