Turczyn Agnieszka, Pańczyk-Tomaszewska Małgorzata, Krzemień Grażyna, Górska Elżbieta, Demkow Urszula
Department of Pediatrics and Nephrology, Medical University of Warsaw, 02-091 Warsaw, Poland.
Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2021 Oct 24;10(21):4899. doi: 10.3390/jcm10214899.
Congenital obstructive nephropathy (CON) leads to renal fibrosis and chronic kidney disease. The aim of the study was to investigate the predictive value of urinary endoglin, periostin, cytokeratin-18, and transforming growth factor-β1 (TGF-β1) for assessing the severity of renal fibrosis in 81 children with CON and 60 controls. Children were divided into three subgroups: severe, moderate scars, and borderline lesions based on 99mTc-ethylenedicysteine scintigraphy results. Periostin, periostin/Cr, and cytokeratin-18 levels were significantly higher in the study group compared to the controls. Children with severe scars had significantly higher urinary periostin/Cr levels than those with borderline lesions. In multivariate analysis, only periostin and cytokeratin-18 were independently related to the presence of severe and moderate scars, and periostin was independently related to borderline lesions. However, periostin did not differentiate advanced scars from borderline lesions. In ROC analysis, periostin and periostin/Cr demonstrated better diagnostic profiles for detection of advanced scars than TGF-β1 and cytokeratin-18 (AUC 0.849; 0.810 vs. 0.630; 0.611, respectively) and periostin for detecting borderline lesions than endoglin and periostin/Cr (AUC 0.777 vs. 0.661; 0.658, respectively). In conclusion, periostin seems to be a promising, non-invasive marker for assessing renal fibrosis in children with CON. CK-18 and TGF-β1 demonstrated low utility, and endoglin was not useful for diagnosing advanced scars.
先天性梗阻性肾病(CON)可导致肾纤维化和慢性肾脏病。本研究旨在探讨尿内皮糖蛋白、骨膜蛋白、细胞角蛋白-18和转化生长因子-β1(TGF-β1)在评估81例CON患儿和60例对照者肾纤维化严重程度方面的预测价值。根据99mTc-乙二巯基半胱氨酸闪烁扫描结果,将患儿分为三个亚组:重度、中度瘢痕和临界病变。与对照组相比,研究组的骨膜蛋白、骨膜蛋白/肌酐和细胞角蛋白-18水平显著更高。重度瘢痕患儿的尿骨膜蛋白/肌酐水平显著高于临界病变患儿。在多变量分析中,只有骨膜蛋白和细胞角蛋白-18与重度和中度瘢痕的存在独立相关,且骨膜蛋白与临界病变独立相关。然而,骨膜蛋白无法区分晚期瘢痕和临界病变。在ROC分析中,与TGF-β1和细胞角蛋白-18相比,骨膜蛋白和骨膜蛋白/肌酐在检测晚期瘢痕方面显示出更好的诊断特征(AUC分别为0.849;0.810 vs. 0.630;0.611),与内皮糖蛋白和骨膜蛋白/肌酐相比,骨膜蛋白在检测临界病变方面的AUC为0.777,而内皮糖蛋白和骨膜蛋白/肌酐分别为0.661;0.658。总之,骨膜蛋白似乎是评估CON患儿肾纤维化的一种有前景的非侵入性标志物。CK-18和TGF-β1的效用较低,内皮糖蛋白对诊断晚期瘢痕无用。