Taşdemir Mehmet, Fuçucuoğlu Dilara, Küçük Suat Hayri, Erol Meltem, Yiğit Özgül, Bilge Ilmay
Division of Pediatric Nephrology, Department of Pediatrics, Koç University Hospital, Davutpaşa cad no: 4 Topkapı, 34010, Istanbul, Turkey.
Department of Pediatrics, Ministry of Health, Bağcılar Training and Research Hospital, Merkez mah, Mimar Sinan cad, 6. sok, Bağcılar, Istanbul, Turkey.
Clin Exp Nephrol. 2018 Feb;22(1):133-141. doi: 10.1007/s10157-017-1436-3. Epub 2017 Jun 26.
To investigate relationships among urinary biomarkers [kidney injury molecule-1 (KIM-1), N-acetyl-β-glucosaminidase (NAG)], neutrophil gelatinase-associated lipocalin (NGAL) levels and renal tubular injury in childhood urolithiasis.
Seventy children [36 girls, mean age: 7.3 ± 5.0 years (0.5-18.2)] with urolithiasis/microlithiasis and 42 controls [18 girls, mean age: 8.5 ± 3.8 years (0.9-16.2)] were included in this multicenter, controlled, prospective cohort study. Patients were evaluated three times in 6-month intervals (0, 6 and 12th months). Anthropometric data, urinary symptoms, family history and diagnostic studies were recorded. Urine samples were analyzed for metabolic risk factors (urinary calcium, uric acid, oxalate, citrate, cystine, magnesium, and creatinine excretion), and the urinary KIM-1, NAG, and NGAL levels were measured.
Stones were mostly located in the upper urinary system (82.9%), and six patients (8.6%) had hydronephrosis. Thirty patients (42.9%) had several metabolic risk factors, and the most common metabolic risk factor was hypocitraturia (22.9%). Urinary KIM-1/Cr, NAG/Cr and NGAL/Cr ratios were not significantly different between patients and controls. Furthermore, no significant changes in their excretion were shown during follow-up. Notably, the urinary KIM-1/Cr, NAG/Cr, and NGAL/Cr levels were significantly higher in children under 2 years of age (p = 0.011, p = 0.006, and 0.015, respectively). NAG/Cr and NGAL/Cr ratios were significantly increased in patients with hydronephrosis (n = 6, p = 0.031 and 0.023, respectively).
The results of this study suggest that none of the aforementioned urinary biomarkers (KIM-1, NAG and NGAL levels) may be useful for the early detection and/or follow-up of renal tubular injury and/or dysfunction in childhood urolithiasis.
研究儿童尿路结石患者尿生物标志物[肾损伤分子-1（KIM-1）、N-乙酰-β-葡萄糖苷酶（NAG）]、中性粒细胞明胶酶相关脂质运载蛋白（NGAL）水平与肾小管损伤之间的关系。
本多中心、对照、前瞻性队列研究纳入了70例尿路结石/微结石患儿[36例女孩，平均年龄：7.3±5.0岁（0.5 - 18.2岁）]和42例对照[18例女孩，平均年龄：8.5±3.8岁（0.9 - 16.2岁）]。患者每隔6个月接受3次评估（第0、6和12个月）。记录人体测量数据、尿路症状、家族史和诊断研究结果。分析尿液样本中的代谢危险因素（尿钙、尿酸、草酸盐、柠檬酸盐、胱氨酸、镁和肌酐排泄量），并测量尿KIM-1、NAG和NGAL水平。
结石大多位于上尿路系统（82.9%），6例患者（8.6%）有肾积水。30例患者（42.9%）有多种代谢危险因素，最常见的代谢危险因素是低枸橼酸尿症（22.9%）。患者和对照之间的尿KIM-1/Cr、NAG/Cr和NGAL/Cr比值无显著差异。此外，随访期间其排泄量无显著变化。值得注意的是，2岁以下儿童的尿KIM-1/Cr、NAG/Cr和NGAL/Cr水平显著更高（分别为p = 0.011、p = 0.006和0.015）。肾积水患者（n = 6）的NAG/Cr和NGAL/Cr比值显著升高（分别为p = 0.031和0.023）。
本研究结果表明，上述尿生物标志物（KIM-1、NAG和NGAL水平）均可能无助于儿童尿路结石患者肾小管损伤和/或功能障碍的早期检测及/或随访。
