Abstract
Background: In this study, the profile of urinary EGF excretion (uEGF/uCreat) was mapped in children presenting with prolonged proteinuria or with nephrotic syndrome refractory to or dependent of steroids. We investigated whether uEGF/uCreat could be linked to the underlying biopsy result, taking into account its response to immunosuppressive medication and to ACE inhibition, as well as genetic predisposition.Methods: Ninety-eight pediatric patients with initial presentation of nephrotic syndrome or prolonged proteinuria were included in this study, along with 49 healthy controls and 20 pediatric Alport patients. All patients had a normal kidney function and were normotensive during the course of the study, whether or not under ACE inhibition. In repeated urine samples, uEGF was measured and concentration was normalized by urine creatinine. In order to compare diagnosis on kidney biopsy, genetic predisposition and response of uEGF/uCreat to immunosuppression and to ACE inhibition, uEGF/uCreat is studied in a linear mixed effects model.Results: Patients with Minimal Change Disease (MCD) showed a significantly different profile of uEGF/uCreat in comparison to healthy children, as well as compared to patients with Focal Segmental Glomerulosclerosis (FSGS) or another glomerulopathy on kidney biopsy. The response of uEGF/uCreat to ACE inhibition was absent in minimal change disease and contrasted with an impressive beneficial effect of ACE inhibition on uEGF/uCreat in FSGS and other proteinuric glomerulopathies. Absence of a genetic predisposition was also associated with a significantly lower uEGF/uCreat.Conclusions: Despite preserved kidney function, children with a proteinuric or nephrotic glomerular disease on kidney biopsy show a significantly lower uEGF/uCreat, indicative of early tubulo-interstitial damage, which appears reversible under ACE inhibition in any underlying glomerulopathy except in minimal change disease. In view of the distinct profile of uEGF/uCreat in minimal change disease compared to other glomerulopathies, and the link between genetic predisposition and uEGF/uCreat, our study suggests that uEGF/uCreat can be a helpful tool to decide on the need for a renal biopsy in order to differentiate minimal change disease from other proteinuric glomerular diseases.
Highlights
Children presenting with a first episode of nephrotic-range proteinuria without kidney failure are prompt treated with high-dose steroids, assuming an underlying minimal change disease (MCD) favorably responding to a single cure of steroids [1,2,3]
From 91 patients 1 to 3 urine samples were collected for measurement of urinary Epidermal Growth Factor (uEGF)/Urinary creatinine (uCreat)
We investigated whether, taking into account genetic predisposition, response to immunosuppressive medication and influence of Angiotensin converting enzyme (ACE) inhibition, uEGF/uCreat could be linked to the underlying biopsy result
Summary
Children presenting with a first episode of nephrotic-range proteinuria without kidney failure are prompt treated with high-dose steroids, assuming an underlying minimal change disease (MCD) favorably responding to a single cure of steroids [1,2,3]. When this idiopathic nephrotic syndrome acquires a frequent relapsing, steroid-dependent, or steroidresistant character, the initiation of other immunosuppressive therapy is most often guided by the findings on kidney biopsy [4, 5]. We investigated whether uEGF/uCreat could be linked to the underlying biopsy result, taking into account its response to immunosuppressive medication and to ACE inhibition, as well as genetic predisposition
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