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BIOMARKERS OF RENAL INJURY RISK IN CHILDREN WITH PYELONEPHRITIS
T Sorokman1, S Sokolnyk1, O Popelyuk1
1Bukovinian State Medical University, Department of Pediatrics and Medical Genetics; Department of human anatomy Mykola Turkevich; Department nursing of higher nursing education; Department of Pharmacology Chernivtsi, Ukraine.
Insights
Pyelonephritis (PN) in infants with urinary anomalies is often linked to congenital issues. Organ-specific enzymes in urine and serum markers like Galectin-3 show promise for diagnosing kidney damage and fibrotic changes in children with PN.
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.
Abstract:
The most common cause of fever in case of anomalies of the urinary system is pyelonephritis (PN). Despite the fact that an intensive search for informative clinical and laboratory markers of PN in children is being conducted in recent years, this problem remains unresolved. Objective - to examine the content of organ-specific enzymes (neutral α-glucosidase (NAG), L-alanine aminopeptidase (AAP), γ-glutamyltranspeptidase (GGTP) in urine and galectin 3 (Gal -3), C-reactive protein (CPR) in blood serum. A prospective, comprehensive clinical and laboratory-instrumental examination was performed in 75 children under the age of 1. The activity of organ-specific enzymes (NAG, AAP, GGTP) in urine and CPR, Gal-3 in the serum of blood were estimated as markers of proximal tubules' damage. The majority (62.99 ± 5.33%) of hospitalized children with febrile temperature and urine changes were diagnosed with PN, which often arose with underlying congenital malformations of the urinary tract. Among children with PN underlaying with VUR, the II and III grades of activity were significantly more frequent. An increase of the level of the enzymes in the urine is observed in the active phase of PN, which correlated with the level of leukocyturia and the level of CRP. During the inactive phase of PN with VUR, the level of enzymes was also higher than the one in children with PN without VUR. High values of Gal-3 were detected in case of underlying VUR, which increased together with increased activity and duration of the inflammatory process in kidneys and correlated with the level of CRP. The Gal-3 can be used for an early diagnosis of fibrotic changes of the renal parenchyma in adolescent children with PN and underlying VUR.
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