| Objective: Congenital hydronephrosis is a common urogenital malformation harmful to children's health.All kinds of reasons lead to long period chronic obstruction of ureter,along with developing of natural course, hydronephrosis turned to be more serious gradually, pelvis and renal calices expanded apparently, renal parenchyma changed gracile and led to severe hydronephrosis,renal function decreased gradually till in the end losted.Due to the process of lesion is slow,it's difficult to find the lesion in earlier period,even when renal function is damaged seriously can it be diagnosed. On the other hand,most children with congenital hydronephrosis need opetration,but the opetration time and indication were still controversial,the reason was the question about functional evaluation of affected kidney and it is also the important evidence to determine whether to keep the affected kidney or not.So, kidney functional evaluation caused by superior urinary tract obstruction is an important topic in clinical study.At present it mainly according to photography examination to instruct clinical therapy such as B ultrasonic,CT and CTU,it is mainly based on morphologic change such as the expanding degree of ureter, pelvis and renal calices and the depth of renal parenchyma.Nuclide nephro-dynamic imaging can get the data about separate kidney blood streamfilling,renal function and morphology,it also can calculate GFR,but some people point out that the markers used by nuclide nephro-dynamic imaging are not ideal,sometimes there isn't obvious differenc between light degree and moderate,severe degree hydronephrosis and it cann't reflect the renal functional damage.There are also many laboratory markers that reflect renal function such as BUN,SCr, endogenous creatinine clearance rate and phenolsulfonphthalein ejection rate,but these markers always increase when renal function was damaged seriously an d cann't reflect renal functional damage in the earlier period. β2-MG is a susceptible marker reflecting renal function damage.Some people found that the change of EGF and TGF- β1 is related to renal pathologic change in hydronephrosis.We detected the level of β 2-MG in serum and urine, EGF in urine and TGF- β1 in serum and urine to study the relationship between these markers and renal functional damage and the degree of renal fibrosis.Method: 53 children were made definite diagnosis of congenital hydronephrosis by B ultrasonic,Computed tomography(CT),computed tomographic urography(CTU).There were 42 boys and 11 girls aged from 30 days to 14 years old,their average age is 51 months old.According to Rickwood hydronephrosis graduated method, 16 of them were light hydronephrosis,24 of them were modest hydronephrosis and 13 of them were severe hydronephrosis.The control group contained 20 normal children,ten boys and ten girls aged from 28 days to 12 years old ,their average age is 50 months old.The children with hydronephrosis were taken peripheral blood on empty stomach,the blood serum was preserved in -80℃ after centrifugation.The urina was taken from pelvic of affected kidney during operation and kept in -80 ℃ after centrifugation.Children in control group were taken urina sanguinis and blood before diet. β2-MG in serum and urine was examined by , EGF in urine and TGF- β1 in serum and urine were examined by enzyme-linked immunoadsordent assay,at the same time, BUN and SCr in serum were examined.These markers were compared and their relativity was studied to judge their value on reflecting renal function and renal pathologic change .Result: (1) β 2-MG:The level of β 2-MG in serum in children with light hydronephrosis doesn't rised compared with control group (P>0.05 ),but that in urine rised significantly (P<0.01) . The level of β 2-MG in serum and in urine in children with moderate and severe hydronephrosis rised significantly compared with control group (P<0.01) . (2) EGF:Compared with control group the level of EGF in urine in children with light hydronephrosis doesn't decrease (P>0.05) , while that in children with moderate and severe hydronephrosis decreases significantly(P<0.01). (3) TGF-β1:The level of TGF- β1 in serum and in urine in children with light hydronephrosis doesn't rised compared with control group (p>0.05 ) ,that in children with moderate and severe hydronephrosis rised significantly (P<0.01) . (4) BUN and SCr:Two markers don't rised in children with light hydronephrosis compared with control group (p>0.05) ,both rise in children with moderate and severe hydronephrosis(P<0.01) .(5)The relativity study among these markers shows no obvious relativity. Conclusion: The level of β2-microglobulin in urine is a sensitive marker to reflect the function of renal tubule.The β2-microglobulin in urine in light degree hydronephrosis increasese obviously indicates the damage of renal tubule, but the β 2-microglobulin in serum doesn't increase significantly,which indicates that the function of renal glomerulus in normal rage. The level of β2-microglobulin in serum and urine rised significantly in children with moderate and severe hydronephrosis indicates that renal function was damaged severely, β 2-microglobulin in serum increased since normal renal glomerulus cann't evacuate it compensately.The study shows that the level of β2-microglobulin in serum and urine is a sensitive marker to reflect renal function,especially the level of β 2-microglobulin in urine can be a sensitive marker to reflect earlier renal function damage.The level of EGF in urine in children with light hydronephrosis doesn't decreased compared with control group,while that in children with moderate and severe hydronephrosis decreased significantly indicates that the ability to synthesis EGF decreases and kidney was damaged severely. The relativity study shows that there is no obvious relativity between EGF in urine and β2-MG in serum and in urine,The level of EGF in urine can reflect renal functional damage, it needs to bestudid advancely to prove whether EGF in urine can be a sensitive marker to reflect renal function. The level of TGF- β1 in serum and in urine in children with light hydronephrosis doesn't rised shows that TGF- β1 synthesised by kidney doesn't rise,that in children with moderate and severe hydronephrosis increases obviously indicates that TGF- β1 synthesised by kidney rised obviously.The level of TGF- β1 in serum and in urine may reflect the degree of reanl fibrosis,it needs further study combining it with renal pathologic change.
|
PDF Full Text Request