Naik Prathibha B, Jindal Bibekanand, Kumaravel S, Halanaik Dhanapathi, Rajappa Medha, Naredi Bikash Kumar, Govindarajan K K
Department of Pediatric Surgery, JIPMER, Puducherry, India.
Department of Nuclear Medicine, JIPMER, Puducherry, India.
J Indian Assoc Pediatr Surg. 2022 Jan-Feb;27(1):83-90. doi: 10.4103/jiaps.JIAPS_334_20. Epub 2022 Jan 11.
To explore the possibility of using urinary biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule-1 (KIM-1) to assess the presence of renal scars in children with Vesicoureteric Reflux (VUR).
This cross-sectional study was conducted in 94 children aged 0-16 years diagnosed with VUR in the Department of Pediatric Surgery, JIPMER. Urinary biomarkers were measured using the enzyme-linked immunosorbent assay kits, normalized with urinary creatinine (Cr) and compared with severity of VUR (low grade [I and II] and high grade [III, IV, and V]), presence or absence of renal scar in VUR patients and severity of renal scar. Independent Student's -test, Mann-Whitney U-test, and analysis of variance Kruskal-Wallis test were used for comparison, and receiver operating characteristic (ROC) curve analysis for predicting the accuracy of biomarkers in detecting the presence of renal scars.
The median urinary NGAL (uNGAL) value was higher in children with renal scar (1.49 ng/mL) than those without renal scar (0.58 ng/mL) and was statistically significant (<0.001). Whereas median uNGAL/Cr was higher in children with renal scar (0.07) than those without renal scar (0.03) but was not statistically significant ( = 0.06). Urinary KIM-1 and urinary KIM-1/urinary Cr (uKIM-1/Cr) was not found to be a significant predictor of renal scar. The difference of uNGAL/Cr was comparable between the grades of renal scar but was not statistically significant. On ROC curve analysis, uNGAL had area under the ROC curve (AUC) of 0.769 with 71% of both specificity and sensitivity, whereas uNGAL/Cr was found to be a poor predictor of renal scar with AUC of 0.611, 60% sensitivity, and 61.2% specificity.
uNGAL can serve as a noninvasive marker for diagnosing the presence of renal scar in children with VUR and a multicentric more extensive cohort study may be needed to strengthen or negate its role.
探讨使用尿生物标志物中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤分子-1（KIM-1）评估膀胱输尿管反流（VUR）患儿肾瘢痕存在情况的可能性。
本横断面研究在JIPMER小儿外科诊断为VUR的94例0至16岁儿童中进行。使用酶联免疫吸附测定试剂盒测量尿生物标志物，用尿肌酐（Cr）进行标准化，并与VUR的严重程度（低级别[I和II级]和高级别[III、IV和V级]）、VUR患者肾瘢痕的有无以及肾瘢痕的严重程度进行比较。采用独立样本t检验、曼-惠特尼U检验和方差分析（Kruskal-Wallis检验）进行比较，并采用受试者工作特征（ROC）曲线分析来预测生物标志物检测肾瘢痕存在情况的准确性。
有肾瘢痕的儿童尿NGAL（uNGAL）中位数（1.49 ng/mL）高于无肾瘢痕的儿童（0.58 ng/mL），且具有统计学意义（<0.001）。而有肾瘢痕的儿童uNGAL/Cr中位数（0.07）高于无肾瘢痕的儿童（0.03），但无统计学意义（P = 0.06）。未发现尿KIM-1和尿KIM-1/尿Cr（uKIM-1/Cr）是肾瘢痕的显著预测指标。不同等级肾瘢痕之间uNGAL/Cr的差异具有可比性，但无统计学意义。在ROC曲线分析中，uNGAL的ROC曲线下面积（AUC）为0.769，特异性和敏感性均为71%，而uNGAL/Cr对肾瘢痕的预测效果较差，AUC为0.611，敏感性为60%，特异性为61.2%。
uNGAL可作为诊断VUR患儿肾瘢痕存在情况的非侵入性标志物，可能需要进行多中心、更广泛的队列研究来强化或否定其作用。
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