Congenital obstructive uropathy (OU) is a leading cause of pediatric kidney failure, representing a unique mechanism of injury, in part from renal tubular stretch and ischemia. Tubular injury biomarkers have potential to improve OU-specific risk stratification.
Patients with OU were identified in the Chronic Kidney Disease in Children (CKiD) study. "Cases" were defined as individuals receiving any kidney replacement therapy (KRT), while "controls" were age- and time-on-study matched and KRT free at last study visit. Urine and plasma neutrophil gelatinase-associated lipocalin (NGAL), interleukin 18 (IL-18), and liver-type fatty acid-binding protein (L-FABP) levels were measured at enrollment and annually and compared between cases and controls. Urine values were normalized to urine creatinine.
In total, 22 cases and 22 controls were identified, with median (interquartile range) ages of 10.5 (9.0-13.0) and 15.9 (13.9-16.9) years at baseline and outcome, respectively. At enrollment there were no differences noted between cases and controls for any urine (u) or plasma (p) biomarker measured. However, the mean pNGAL and uL-FABP/creatinine increased throughout the study period in cases (15.38 ng/ml per year and 0.20 ng/ml per mg/dl per year, respectively, p = 0.01 for both) but remained stable in controls. This remained constant after controlling for baseline glomerular filtration rate (GFR).
In children with OU, pNGAL and uL-FABP levels increased over the 5 years preceding KRT; independent of baseline GFR. Future studies are necessary to identify optimal cutoff values and to determine if these markers outperform current clinical predictors.
Pediatric nephrology (Berlin, Germany). 2020 May 22 [Epub ahead of print]
Daryl J McLeod, Yuri V Sebastião, Christina B Ching, Jason H Greenberg, Susan L Furth, Brian Becknell
Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA. ., Center for Surgical Outcomes Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA., Section of Urology, Nationwide Children's Hospital, Columbus, OH, 43205, USA., Department of Pediatrics, Section of Nephrology, Yale University School of Medicine, New Haven, CT, 06510, USA., Department of Pediatrics, Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA., Center for Clinical and Translational Research, Nationwide Children's Hospital, Columbus, OH, 43205, USA.