Department of Pediatric Kidney, Liver and Metabolic Diseases, Children's Hospital, Hannover Medical School, Hannover, Germany.
Pediatr Nephrol. 2010 Sep;25(9):1673-8. doi: 10.1007/s00467-010-1455-8. Epub 2010 Feb 24.
One out of every five children suffering from ureteropelvic junction obstruction (UPJO) requires pyeloplasty. This prevalence indicates an urgent necessity to identify high-grade UPJO as early as possible to avoid renal damage. A novel non-invasive proteomic urine test has recently been introduced that is able to detect these patients at an early stage. In the study reported here, we tested this approach to assess its use in our centre and to expand its application to older children. Twenty-seven children (median age 0.4 years, range 0.1-8.8 years) with hydronephrosis who had been scheduled a nuclear diuretic renal scan (DR) to identify urodynamically relevant UPJO were included in our prospective study. Patients with prior surgery of the urinary tract were excluded. The urinary proteome pattern was analysed using capillary electrophoresis coupled to mass spectrometry. Of the 27 children, 11 had a relevant UPJO diagnosed by the DR. In 19 children <1 year of age, urinary proteome analysis predicted obstruction with a sensitivity of 83% (5/6) and a specificity of 92% (12/13). However, in older patients, the sensitivity decreased to 20% (1/5) and specificity to 66% (2/3). Based on our results, the proteome pattern established by Decramer and co-workers predicts the need for surgery in infants but not in older children with UPJO.
每五个患有肾盂输尿管连接部梗阻 (UPJO) 的儿童中就有一个需要进行肾盂成形术。这种患病率表明，迫切需要尽早识别出高级别 UPJO，以避免肾脏损伤。最近引入了一种新的非侵入性蛋白质组尿液检测方法，能够在早期发现这些患者。在本报告的研究中，我们测试了这种方法，以评估其在我们中心的使用情况，并将其应用扩展到年龄较大的儿童。我们对 27 名患有肾积水且已安排核利尿剂肾扫描 (DR) 以确定与尿动力学相关 UPJO 的儿童进行了前瞻性研究。排除了有尿路手术史的患者。使用毛细管电泳与质谱联用分析尿液蛋白质组模式。在 27 名儿童中，11 名儿童的 DR 诊断为相关 UPJO。在 19 名 <1 岁的儿童中，尿蛋白质组分析预测梗阻的敏感性为 83%（5/6），特异性为 92%（12/13）。然而，在年龄较大的患者中，敏感性降至 20%（1/5），特异性降至 66%（2/3）。根据我们的结果，Decramer 及其同事建立的蛋白质组模式可预测婴儿是否需要手术，但不能预测 UPJO 年龄较大的儿童是否需要手术。
