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Urinary DKK3 as a predictor of CKD stages in reflux nephropathy in children

Ayşe Seda Pinarbaşi1, Neslihan Günay2, İnayet Güntürk3

  • 1Division of Pediatric Nephrology, Department of Pediatrics, Eskişehir Yunus Emre State Hospital, Eskişehir, Turkiye.

Turkish Journal of Medical Sciences
|July 25, 2026
PubMed

Insights

Urinary Dickkopf-3 (uDKK3) shows potential as a biomarker for advanced chronic kidney disease (CKD) in children with reflux nephropathy. Higher uDKK3 levels correlate with more severe CKD, but its role in early stages requires further investigation.

Area of Science:

  • Pediatric Nephrology
  • Biomarker Discovery
  • Chronic Kidney Disease (CKD)

Background:

  • Reflux nephropathy is a significant cause of pediatric CKD.
  • Early intervention is crucial for slowing CKD progression.
  • Urinary Dickkopf-3 (uDKK3) is a potential biomarker for tubulointerstitial fibrosis, with limited pediatric data.

Purpose of the Study:

  • To investigate the role of urinary Dickkopf-3 (uDKK3) levels in predicting CKD stage in children with reflux nephropathy.
  • To assess the association between uDKK3, estimated glomerular filtration rate (eGFR), and albuminuria.
  • To evaluate the diagnostic performance of uDKK3 for CKD severity.

Main Methods:

  • Cross-sectional study of 113 children with CKD stages 1-4 and 28 healthy controls.
  • Measurement of uDKK3 concentrations via enzyme-linked immunosorbent assay (ELISA).
  • Correlation analysis with eGFR and albuminuria; Receiver Operating Characteristic (ROC) curve analysis.

Main Results:

  • Significantly higher uDKK3 levels in advanced CKD stages (3-4) compared to early stages (1-2) and controls.
  • Strong negative correlation between uDKK3 and eGFR; positive correlation with albuminuria.
  • ROC analysis for uDKK3/urinary creatinine ratio (uDKK3/uCr) showed an AUC of 0.77, with 71.1% sensitivity and 71.4% specificity.

Conclusions:

  • The uDKK3/uCr ratio may serve as a noninvasive biomarker for assessing pediatric CKD severity in reflux nephropathy.
  • uDKK3 utility in identifying early-stage CKD was not clearly demonstrated.
  • Further large-scale prospective studies are needed to confirm the clinical applicability and prognostic value of uDKK3 in pediatric CKD.
Abstract

Keywords:
Urinary DKK3childrenchronic kidney diseasereflux nephropathy

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