Department of Pediatrics, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
Department of Surgery, Children's National Health System, 111 Michigan Ave NW, Washington, DC, 20010, USA.
J Pediatr Urol. 2019 Apr;15(2):155.e1-155.e6. doi: 10.1016/j.jpurol.2018.12.008. Epub 2019 Jan 23.
Neutrophil gelatinase-associated lipocalin (NGAL) is a marker of acute kidney injury, and has been shown to be a sensitive marker of renal damage in urinary tract obstruction. Children with neurogenic bladders are at risk of renal damage as a result of increased pressure within the urinary system. A marker of upper tract deterioration in this population would be useful to guide management.
The aim of the study is to compare urinary NGAL (uNGAL) concentrations between children who have elevated and normal detrusor pressure and between those with low and normal compliance, on urodynamics.
This is a cross-sectional study of children with neurogenic bladder who underwent routine urodynamics from August 2015 to March 2016. Patients with positive urine cultures from the time of urodynamics were excluded from analysis. Urine was obtained from the time of urodynamics for uNGAL measurement. Urodynamics were reviewed. High pressure is defined as a detrusor pressure of 40 cm of water or greater at the volume where catheterization is normally performed. Compliance was calculated at the volume where catheterization is performed.
A total of 89 patients were included (low pressure, n = 73; high pressure, n = 16 and low compliance, n = 41; normal compliance, n = 40). Median uNGAL concentrations were not different between patients with low and high pressure, but there was a higher median uNGAL concentration in patients with normal compliance compared with those with low compliance. There was no correlation between maximum detrusor pressure and uNGAL concentration, but there was a moderate relationship between compliance and uNGAL concentration (r = 0.43, p < 0.01 for non-normalized uNGAL and r = 0.30, p < 0.01 for normalized uNGAL).
There is an increase in uNGAL concentrations in patients with normal compliance compared with those with low compliance, but no difference between patients with low or high pressure.
中性粒细胞明胶酶相关脂质运载蛋白（NGAL）是急性肾损伤的标志物，已被证明是尿路梗阻中肾损伤的敏感标志物。由于泌尿系统内压力增加，患有神经性膀胱的儿童有肾损伤的风险。在该人群中，一种上尿路恶化的标志物将有助于指导治疗。
本研究旨在比较尿中性粒细胞明胶酶相关脂质运载蛋白（uNGAL）浓度在压力升高和正常的逼尿肌压力之间以及顺应性降低和正常的逼尿肌压力之间的差异。
这是一项对 2015 年 8 月至 2016 年 3 月间接受常规尿动力学检查的神经源性膀胱患儿的横断面研究。尿动力学检查时尿液培养阳性的患者被排除在分析之外。尿动力学检查时采集尿液进行 uNGAL 测量。回顾尿动力学检查结果。高压力定义为在通常行导管插入术的容量时逼尿肌压力达到 40cm 水柱或更高。顺应性在进行导管插入术的容量处计算。
共纳入 89 例患者（低压力组，n=73；高压力组，n=16；低顺应性组，n=41；正常顺应性组，n=40）。低压力和高压力患者的 uNGAL 浓度中位数无差异，但正常顺应性患者的 uNGAL 浓度中位数高于低顺应性患者。最大逼尿肌压力与 uNGAL 浓度之间无相关性，但顺应性与 uNGAL 浓度之间存在中度相关性（未归一化 uNGAL 的 r=0.43，p<0.01；归一化 uNGAL 的 r=0.30，p<0.01）。
与低顺应性患者相比，正常顺应性患者的 uNGAL 浓度升高，但压力低和压力高的患者之间无差异。
