Early markers for the development and progression of reflux nephropathy in children

PURPOSE. TO DETERMINE THE CLINICAL SIGNIFICANCE OF URINARY EXCRETION OF THE TRANSFORMING GROWTH FACTOR (TGF-ß, ), ANGIOTENSIN II (Ang II) AND ß2-MICROGLOBULIN (ß2-MG) IN CHILDREN WITH VESICOURETERAL REFLUX (VUR) FOR EARLY DETECTION AND PROGNOSIS OF THE PROGRESSION OF REFLUX NEPHROPATHY (RN). MATERIAL AND METHODS, SEVENTY-NINE PATIENTS WITH VARYING DEGREES OF VUR AGED I TO 14 YEARS (MEAN AGE 5.69±0.44 YEARS), 58 (73.4%) GIRLS. DEPENDING ON THE RESULTS OF DMSA-SCINTIGRAPHY AND THE APPLICATION TASK, THE PATIENTS WERE DIVIDED INTO THE FOLLOWING GROUPS: COMPARISON GROUP (GROUP 1) - PATIENTS WITH DIFFERENT DEGREES OF VUR WITHOUT RN (N=12, MEAN AGE - 1.65±0.31 YEARS), 8 GIRLS (66.7%). THE MAIN GROUP INCLUDED 67 CHILDREN WITH RN (5.64±0.81 YEARS), AND DEPENDING ON THE SEVERITY OF RN WAS DIVIDED INTO 2 GROUPS: GROUP 2-27 CHILDREN WITH MILD (I-II) DEGREE OF RN (5.89±0.77 YEARS), 19 (70.4%) GIRLS, AND GROUP 3-40 CHILDREN WITH SEVERE (III-IV) DEGREE OF RN (5.4 1 ± 1.07 YEARS), 31 (77.5 %) GIRLS. DEPENDING ON THE COURSE OF RN, BOTH GROUPS WERE DIVIDED INTO SUBGROUPS: 2А (WITHOUT PROGRESSION OF RN) - WITH RN OF I-II DEGREES (N= 1 6, MEAN AGE - 5.34±0.23 YEARS), 1 1 (68.8%) GIRLS; 2B (WITH PROGRESSION OF RN) - WITH RN OF I-II DEGREES (N=11, MEAN AGE 6.43±0.86 YEARS), 8 (72.7%) GIRLS; ЗА (WITHOUT PROGRESSION OF RN) - WITH RN OF III-IV DEGREES (N=18, MEAN AGE - 6.17±0.55 YEARS),14 (77.8%) GIRLS; 3B (WITH PROGRESSION) - WITH RN OF III-IV DEGREES (N = 22, AVERAGE AGE - 4.65±0.45 YEARS),17 (72.3%) GIRLS; GROUP 4 (CONTROL) 20 APPARENTLY HEALTHY CHILDREN (6.24±0.31 YEARS), 12 (60%) GIRLS. THE STUDY GROUPS OF PATIENTS DID NOT DIFFER SIGNIFICANTLY IN SEX AND AGE. ALL CHILDREN UNDERWENT EXAMINATION OF URINARY EXCRETION OF ANGlI, TGF-ß,, ß2-MG IN THE MORNING URINE AND REVALUATION RESULTS TO URINARY CREATININE LEVEL. RESULTS. THE URINARY LEVELS OF ANGII, TGF-ß,, ß2-MG WERE SIGNIFICANTLY HIGHER IN THE GROUPS OF CHILDREN WITH RN THAN IN THE CONTROL GROUP. INCREASE IN ANG II AND TGF-ß, LEVELS WAS SIGNIFICANTLY HIGHER IN THE MAIN GROUP THAN IN THE COMPARISON GROUP (P<0.05). THE MOST SENSITIVE MARKERS FOR EARLY DETECTION OF RN ARE ANGlI AND TGF-ß,; GLOMERULAR FILTRATION RATE (GFR) AND ß2-MG REFLECT THE PROGRESSION OF RN. REDUCTION IN GFR IS AN UNFAVORABLE AND MORE CHARACTERISTIC SIGN FOR A SEVERE DEGREE OF RN AND FOR ITS PROGRESSIVE COURSE. CONCLUSION. THE DIRECT CORRELATION REVEALED BETWEEN THE LEVEL OF EXCRETION OF THE STUDIED PRO-FIBROGENIC FACTORS AND THE DEVELOPMENT OF RN INDICATES THE ADVISABILITY AND POTENTIALS FOR THEIR INCLUSION AS DIAGNOSTIC MARKERS OF EARLY DETECTION OF RN. THE URINARY ß2-MG LEVEL IS MORE REFLECTIVE OF THE PROGRESSIVE COURSE OF RN.

VESICOURETERAL REFLUX, REFLUX NEPHROPATHY, MARKERS OF SCLEROSING