BIOMARKERS OF RENAL INJURY RISK IN CHILDREN WITH PYELONEPHRITIS

Area of Science:

• Pediatric Nephrology
• Clinical Biochemistry
• Urology

Background:

• Pyelonephritis (PN) is a common cause of fever in children with urinary system anomalies.
• Current diagnostic markers for PN in children are insufficient, necessitating research into novel biomarkers.
• Congenital malformations frequently underlie PN in pediatric patients.

Purpose of the Study:

• To investigate the utility of urinary organ-specific enzymes (neutral α-glucosidase, L-alanine aminopeptidase, γ-glutamyltranspeptidase) and serum markers (galectin-3, C-reactive protein) for diagnosing PN in infants.
• To assess the correlation between these markers and the severity of PN, particularly in cases associated with vesicoureteral reflux (VUR).
• To explore the potential of galectin-3 for early detection of renal parenchymal fibrosis in children with PN and VUR.

Main Methods:

• A prospective study involving 75 infants under one year old with fever and urinary changes.
• Measurement of urinary enzymes (NAG, AAP, GGTP) and serum markers (Gal-3, CRP) as indicators of proximal tubule damage.
• Clinical and instrumental examinations to diagnose PN and assess VUR grades.

Main Results:

• PN was diagnosed in the majority of hospitalized children, often associated with congenital urinary tract malformations.
• Elevated urinary enzyme levels correlated with active PN, leukocyturia, and CRP levels.
• Higher urinary enzyme levels were observed in the inactive phase of PN with VUR compared to PN without VUR.
• Increased Gal-3 levels were associated with underlying VUR, inflammatory activity, and CRP, suggesting its role in diagnosing fibrotic changes.

Conclusions:

• Urinary organ-specific enzymes and serum Gal-3 are valuable markers for assessing kidney damage in pediatric PN.
• Gal-3 shows potential for early diagnosis of renal fibrosis in children with PN and VUR.
• Congenital anomalies, especially VUR, are significant factors in pediatric PN and influence marker expression.