Division of Pediatric Urology, Department of Urology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Department of Urology, Koç University School of Medicine, Istanbul, Turkey.
Pediatr Surg Int. 2022 Mar;38(3):499-503. doi: 10.1007/s00383-021-05059-x. Epub 2022 Jan 31.
Distinguishing hydronephrosis that requires surgical intervention is a clinical challenge. The aim of this study is to determine the level of urinary heat shock protein 70 (HSP70) in children who required surgery for ureteropelvic junction obstruction and its potential use as a biomarker for prediction of surgery in children with isolated unilateral hydronephrosis.
The data of 43 children with ureteropelvic junction obstruction who underwent pyeloplasty, 25 patients with non-obstructive dilation (NOD) and 30 healthy children (control group) were collected prospectively for this study. Preoperative and postoperative urinary HSP70/Cr levels were also analyzed in 30 children in the pyeloplasty group who had available follow-up information. HSP70 levels were assessed using ELISA.
The median age of the pyeloplasty group was 13 months (IQR 7-36 months), NOD group was 42.5 months (IQR 16-73) and it was 36 months (IQR 24-47.5) in the control group. The mean preoperative urinary HSP70/Cr was significantly higher in the pyeloplasty group when compared to controls as well as the NOD group (150.6 pg/mgCr vs. 65.0 pg/mgCr and vs. 64.7 pg/mgCr, p < 0.001 and p < 0.001, respectively). The urinary HSP70 levels significantly decreased in the postoperative period (151.5 vs 79.5, p < 0.001). Using the cutoff value of 94.7 pg/mgCr, the sensitivity and specificity of urinary HSP70 for predicting the risk of surgical intervention were 69.7% and 68%, respectively (AUC = 0.689).
Urinary HSP70 may be used as an adjunct tool to clinical parameters to identify patients that would require surgery due to ureteropelvic junction obstruction.
鉴别需要手术干预的肾盂积水是临床面临的挑战。本研究旨在确定需要手术治疗肾盂输尿管连接部梗阻的儿童尿液中热休克蛋白 70（HSP70）的水平，并探讨其作为预测儿童单侧单纯性肾盂积水手术适应证的潜在生物标志物的价值。
前瞻性收集 43 例行肾盂成形术的肾盂输尿管连接部梗阻患儿（梗阻组）、25 例非梗阻性扩张患儿（非梗阻组）和 30 例健康儿童（对照组）的临床资料。对其中 30 例梗阻组术后有随访资料的患儿，分析术前、术后尿 HSP70/Cr 水平。采用 ELISA 法检测 HSP70 水平。
梗阻组患儿的中位年龄为 13 个月（736 个月），非梗阻组为 42.5 个月（1673 个月），对照组为 36 个月（24~47.5 个月）。与对照组和非梗阻组比较，梗阻组患儿术前尿 HSP70/Cr 水平均显著升高（150.6 pg/mgCr 比 65.0 pg/mgCr 和 64.7 pg/mgCr，P 值均<0.001）。术后 HSP70 水平显著降低（151.5 比 79.5，P 值均<0.001）。以 94.7 pg/mgCr 为截断值，尿 HSP70 预测手术干预风险的敏感度和特异度分别为 69.7%和 68%（AUC=0.689）。
尿 HSP70 可作为临床参数的辅助工具，用于识别因肾盂输尿管连接部梗阻而需要手术的患者。
