Conservative Approach in Neonatal High-Grade Hydronephrosis is Associated with Significant Increase of Serum Tgf ß-1

Abstract

Purpose To compare serum TGF s-1, a mediator of irreversible interstitial renal fibrosis, according to the type of treatment of high-grade neonatal hydronephrosis. Material and Methods 25 newborns with unilateral hydronephrosis grade III.-IV. and initial differential renal function more than 40% were prospectively assigned for early surgery (group A). Another 27 patients were assigned for conservative treatment; seven of them were converted to surgery because of increasing hydronephrosis or deterioration of renal function (group B), and 20 were followed conservatively (group C). All children underwent series of ultrasound, MAG-3 renography evaluations, and serum TGF s-1 was repeatedly assessed. Results In group A, serum TGF β-1 decreased from preoperarative O 32,3ng/ml to O 20,5ng/ml postoperatively (p=0,0122) after a mean follow up of 13 months (3-48). In group B, the TGF β 1 values increased insignificantly during conservative (O 16,5ng/ml to O 21,4ng/ml) and after subsequent surgery (O 23,8ng/ml; p=0,1078). In group C, the TGF β-1 values demonstrated a continuous increase from O 22,5ng/ml to O 36,6ng/ml (p=0,0022) after a mean follow up of 23 months (12-54). The initial mean AP diameter, parenchymal thickness and differential renal function in group A was 26 mm/4,3 mm/49 %, in group B 23,9 mm/5,9 mm/ 48 %, in group C 21,1mm/5,3mm/50%, and changed finally to 11,2mm/9,1mm/51%, 12mm/7,5mm/47% and 18.5mm/8,6mm/50% respectively. Conclusions In contrast to surgical treatment, conservative approach in neonatal high-grade hydronephrosis with stabile renal function and morphology is associated with significant increase of serum TGF β-1. Further follow up is needed to detect possible late consequences of this finding.