Role of Urinary Biomarkers in the Diagnosis of Congenital Upper Urinary Tract Obstruction

Abstract

Objective: Congenital obstructive uropathy constitutes a significant cause of morbidity in children. Currently, there is no reference standard for the diagnosis of renal obstruction in children. The non-invasive measurement of biomarkers in voided urine has considerable appeal as a potential application in children with congenital obstructive nephropathy. The aim of the present review is to explore the current role of biomarkers in the diagnosis and follow-up of obstructive uropathy in children.
Patients and Methods: The literature database (PubMed) was searched from inception to May 2007, regarding the role of urinary biomarkers in the diagnosis and follow-up of children with congenital obstructive uropathy.
Results: The review included 23 experimental and 33 prospective controlled clinical studies. Several cytokines, peptides, enzymes and microproteins were identified as major contributors to, or as biomarkers ensuing from obstruction-induced renal fibrosis and apoptosis. The most important biomarkers were transforming growth factor-β1 (TGF-β1), epidermal growth factor (EGF), endothelin-1 (ET-1), urinary tubular enzymes [N-acetyl-β-D-glucosaminidase (NAG), γ-glutamyl transferase (GGT) and alkaline phosphatase (ALP)], and microproteins [β2- microglobulin (β2M), microalbumin (M.Alb) and micrototal protein (M.TP)]. All biomarkers showed different degrees of success but the most promising markers were TGF-β1, ET-1 and a panel of tubular enzymes. These biomarkers showed a sensitivity of 74.3% to 100%, a specificity
of 80% to 90% and an overall accuracy of 81.5% to 94% in the diagnosis of congenital obstructive uropathy in children. Moreover, some of the markers were valuable in differentiation between dilated non-obstructed kidneys qualifying for conservative management and obstructed kidneys requiring surgical correction. Some studies demonstrated that urinary biomarkers are helpful in evaluating the success of treatment in children with congenital renal obstruction. Some limitations of the previous studies include lack of controls and small sample size. Larger controlled studies are necessary to confirm the clinical usefulness of biomarkers in the diagnosis and follow-up of children with congenital obstructive uropathy.
Conclusion: Urinary biomarkers are a promising tool that could be used as a non-invasive assessment of congenital renal obstruction in children.


Keywords: urine, kidney, children, obstruction

African Journal of Urology Vol. 13 (3) 2007: pp. 179-187