Department of Nephrology, Prof. Dr. Juan P. Garrahan Children's Hospital, Combate de los Pozos 1881, 1245 Buenos Aires, Argentina.
Pediatr Nephrol. 2010 Jun;25(6):1177-80. doi: 10.1007/s00467-009-1434-0. Epub 2010 Feb 16.
About 25-50% of survivors of the acute phase of postdiarrheal hemolytic uremic syndrome (D+ HUS) develop chronic renal disease. Transforming growth factor beta-1 (TGFbeta-1) is the main fibrogenic growth factor in humans, and there is a significant correlation between its levels and the grade of interstitial fibrosis in chronic nephropathies. We hypothesized that increased urinary TGFbeta-1 may be an early indicator of sequelae in D+ HUS patients who show no sign of renal damage as determined by conventional diagnostic tests. We therefore compared the levels of TGFbeta-1 in urine collected from healthy controls (HC) (n = 18) with that from patients with a past history of D+ HUS (n = 39). We found that TGFbeta-1 excretion was significantly higher (p < 0.001) in the patient group (median level 73 pg/mg creatinine) than in the HC (median level 28 pg/mg creatinine). TGFbeta-1 excretion did not correlate with age, white blood cell count, length of oligoanuric period, maximum creatinine at the acute stage, or length of the follow-up. Since TGFbeta-1 excretion may reflect ongoing renal tissue damage, our results emphasize the need for the lifelong follow-up of patients with a past history of D+ HUS, even those showing apparent recovery. Long-term monitoring of this cohort is necessary to determine the clinical utility of our findings.
大约 25-50% 的腹泻后溶血尿毒症综合征（D+ HUS）急性期幸存者会发展为慢性肾脏疾病。转化生长因子β-1（TGFβ-1）是人类主要的纤维生成生长因子，其水平与慢性肾脏病间质纤维化程度之间存在显著相关性。我们假设，在 D+ HUS 患者中，尿液中 TGFβ-1 水平升高可能是一种早期指标，这些患者虽然没有通过常规诊断检测到肾脏损伤的迹象，但可能会出现后遗症。因此，我们比较了健康对照组（HC）（n=18）和过去有 D+ HUS 病史的患者（n=39）尿液中 TGFβ-1 的水平。结果发现，患者组（中位数水平为 73pg/mg 肌酐）的 TGFβ-1 排泄量明显高于 HC（中位数水平为 28pg/mg 肌酐）（p<0.001）。TGFβ-1 排泄量与年龄、白细胞计数、少尿期长度、急性期最大肌酐或随访时间均无相关性。由于 TGFβ-1 的排泄可能反映了持续的肾脏组织损伤，因此我们的研究结果强调，即使那些表现出明显恢复的 D+ HUS 患者也需要终身随访。对该队列进行长期监测对于确定我们发现的临床实用性是必要的。
