Role of urinary transforming growth factor-beta1 concentration in the diagnosis of upper urinary tract obstruction in children.

Abstract

We evaluate the role of transforming growth factor-beta1 (TGF-beta1) in the diagnosis and followup of children with pelviureteral junction obstruction. TGF-beta1 concentration was measured in renal pelvic and bladder urine samples obtained from 15 children who underwent surgery for symptomatic unilateral pelviureteral junction obstruction. Bladder urine TGF-beta1 was also measured in 11 age matched patients with dilated nonobstructed kidneys as documented by nonobstructed washout curve and half-time drainage less than 10 minutes on diuretic renography. In the obstructed group bladder urine TGF-beta1 was measured 3 months after surgery. In the obstructed group mean TGF-beta1 plus or minus SD in the renal pelvic urine was 285 +/- 191 pg./mg. creatinine, or 4-fold that of bladder urine (p >0.001). Mean bladder urine TGF-beta1 was 3-fold higher in patients with upper tract obstruction than in controls (68 +/- 59 versus 22 +/- 18 pg./mg. creatinine, p <0.003). Mean bladder TGF-beta1 3 months after surgery showed a trend towards a decrease, albeit still insignificant (68 +/- 59 versus 39 +/- 31 pg./mg. creatinine for preoperatively versus postoperatively, p <0.08). Using a bladder urine concentration of 29 pg./mg. creatinine as a cutoff between obstruction and no obstruction, TGF-beta1 was 80% sensitive, 82% specific and 81% accurate for the diagnosis of obstruction. Bladder urine TGF-beta1 is a useful noninvasive tool for diagnosis of upper urinary tract obstruction. At 3 months following corrective surgery there is a trend towards decrease in bladder TGF-beta1 concentration in comparison to the preoperative value.