Pelvi‐ureteric junction obstruction in children: the role of urinary transforming growth factor‐β1 and epidermal growth factor

• Published in: BJU international Vol. 99; no. 4; pp. 899 - 903
• Main Authors: Taha, Mohamed A., Shokeir, Ahmed A., Osman, Hussein G., Abd El‐Aziz, Abd El‐Aziz F., Farahat, Sami E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2007; Blackwell
• Subjects: Biological and medical sciences; children; epidermal growth factor; kidney; Medical sciences; Nephrology. Urinary tract diseases; obstruction; transforming growth factor β1; urine; Human; Urine; Nephrology; obstruction; Kidney; Urology; Epidermal growth factor; Urinary system; children; Junction; Pyeloureteral junction obstruction; Transforming growth factor β1; Child
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1111/j.1464-410X.2006.06641.x

In this section authors from Egypt describe the use of urinary TGFβ1 and epidermal growth factor in PUJ obstruction. In another paper, authors from London herald what they consider to be a new era in the management of end‐stage renal disease in children, presenting the technique of bilateral synchronous posterior prone retroperitoneoscopic nephrectomy with simultaneous peritoneal dialysis.
OBJECTIVES
To investigate the role of transforming growth factor β1 (TGF‐β1) and epidermal growth factor (EGF) in voided urine for the diagnosis and follow‐up of children with pelvi‐ureteric junction obstruction (PUJO).
PATIENTS, SUBJECTS AND METHODS
The study included 35 children with unilateral PUJO who had a pyeloplasty, and 30 healthy control children. Urine samples were obtained from the bladders of patients before surgery, and as voided samples at 1, 2, 3, 6, 9 and 12 months after surgery. Bladder urine samples were also collected from all 30 children in the control group. TGF‐β1 and EGF were then measured in all the urine samples.
RESULTS
The level of bladder TGF‐β1 before surgery in the patients was significantly higher than that in the healthy control group. A threshold of 190 pg/mg creatinine gave a sensitivity of 100%, a specificity of 80%, a positive predictive value of 85.4%, negative predictive value of 100% and an overall accuracy of 90.8%. Compared with the value before surgery, urinary TGF‐β1 was significantly lower at 1 year after pyeloplasty. There was no significant difference between the level of EGF before surgery in the patients and that in the control group, and no significant difference in the level of EGF before and after surgery over the follow‐up.
CONCLUSION
We do not recommend using EGF levels in voided urine in the routine diagnosis of children with hydronephrosis. The urinary level of TGF‐β1 is a useful noninvasive tool for the long‐term follow‐up of children with PUJO treated by pyeloplasty. Further studies with various controls are required to confirm the diagnostic accuracy of TGF‐β1 in children with PUJO.