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Prediction of the outcome of antenatal hydronephrosis: significance of urinary EGF

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Abstract

Background

Down-regulation of epidermal growth factor (EGF) in the renal parenchyma has been demonstrated in children who underwent pyeloplasty due to ureteropelvic junction obstruction (UPJO). Urine levels of EGF were confirmed to parallel this finding before and after surgery. The aim of our study was to evaluate the relationship between urinary EGF (uEGF) concentrations and Society of Fetal Urology (SFU) high-grade hydronephrosis in infants presenting unilateral antenatal hydronephrosis (ANH).

Methods

This was a prospective study involving 45 infants (33 in the observational group, 12 in the surgical group) who presented with unilateral ANH. Postnatal evaluation included a clinical examination, renal ultrasonography, and voiding cystourethrography. Diuretic renal scans were performed in infants with an initial SFU grade 3 or 4 hydronephrosis or increasing hydronephrosis during follow-up. Pyeloplasty was performed when a well-tempered renogram showed an obstructive drainage curve with a half-life of >20 min and/or an obstructive washout curve pattern during the diuretic phase. We studied the longitudinal changes in SFU hydronephrosis grade and uEGF in each group and compared concentration levels at three time points in both groups. The enzyme-linked immunosorbent assay (ELISA) method was used to measure EGF concentrations in the urine. The results were normalized with urinary creatinine (Cr).

Results

During the first 6 months, from 6 to 12 months, and in the second year of life, median SFU hydronephrosis grade and uEGF levels were 2, 2 (p = 0.015), and 1 (p < 0.01), and 50, 59 (p = 0.015), and 69.5 ng/mg Cr (p < 0.01), respectively, in the observational group. In the first 6 months, preoperatively and at 3–12 months postoperatively, the median SFU hydronephrosis grade and uEGF levels were 4, 4, and 3 (p > 0.05), and 38, 46, (p > 0.05), and 55 ng/mg Cr (p < 0.01), respectively, in the surgical group. uEGF levels in the first 6 months of life were significantly lower in the surgical group than in the observational group (p < 0.01). Patients in the observational group with SFU grade 3–4 hydronephrosis showed higher uEGF levels than those in the surgical group with SFU grade 3–4 in (p = 0.048).

Conclusions

Urinary EGF changes over time are associated with inverse changes in SFU hydronephrosis grade, which suggests a role for uEGF as a predictive marker of worsening hydronephrosis grades in infants with ANH. uEGF in the first 6 months of life may predict the need for surgery in infants with ANH.

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Acknowledgments

This study was supported by “The Youth Innovation Fund of the First Affiliated Hospital of Zhengzhou University” and Special Research Fund for the Doctoral Program of Colleges of Ministry of Education (No. 20114101120010). Prof. Robert Levin, Albany College of Pharmacy, Albany, NY, USA and Dr. Forrest Arp, Nant Works Corp, Los Angeles, CA, USA are thanked for their valuable comments.

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Authors and Affiliations

  1. The Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China

    Zhenzhen Li, Zhiqiang Su & Jianguo Wen

  2. Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China

    Zhanzheng Zhao

  3. Pathological Experiment Center, Henan University of Traditional Chinese Medicine, Zhengzhou City, Henan, China

    Xianghua Liu

  4. Pediatric Urodynamic Center, Urology Department, The Institute of Clinical Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, 450052, Henan, China

    Zhiqiang Su & Jianguo Wen

  5. Medical Records Department , The First Affiliated Hospital of Zhengzhou University, Zhengzhou City, Henan, China

    Xiaoping Shang

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  1. Zhenzhen Li
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  2. Zhanzheng Zhao
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Correspondence to Jianguo Wen.

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Li, Z., Zhao, Z., Liu, X. et al. Prediction of the outcome of antenatal hydronephrosis: significance of urinary EGF. Pediatr Nephrol 27, 2251–2259 (2012). https://doi.org/10.1007/s00467-012-2243-4

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  • DOI: https://doi.org/10.1007/s00467-012-2243-4

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