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Urinary Excretion of Various Urinary Proteins in Children with Vesicoureteral Reflux

Journal of the Korean Pediatric Society 2003;46(10):977-982.
Published online October 15, 2003.
Urinary Excretion of Various Urinary Proteins in Children with Vesicoureteral Reflux
Da Eun Jung, Ja Wook Koo
Department of Pediatrics, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul, Korea
방광요관 역류증 환아에서의 다양한 요단백의 배설
정다은, 구자욱
인제대학교 의과대학 상계백병원 소아과
Correspondence: 
Ja Wook Koo, Email: koojw9@sanggyepaik.ac.kr
Abstract
Purpose
: This study aimed to examine the excretion of various urinary proteins in children with a history of urinary tract infection(UTI), with or without vesicoureteral reflux(VUR) or reflux nephropathy, and to identify means of predicting the severity of VUR or the presence of reflux nephropathy as indicated by these markers, and to know how these markers are changed after resolution of VUR.
Methods
: We studied 30 children with previous UTI, without VUR and renal scarring(group I), 12 children with VUR, without evidence of renal scarring(group II), and 34 children with VUR and renal scarring(group III). 24-hour or 12-hour urine β2 microglobulin(β2 MG), microalbumin and N- acetyl-β-D-glucosaminidase(NAG) were measured in each child. Urinary protein excretions were analyzed according to the degree of VUR(mild VUR : a grade reflux I-III, severe VUR : a grade reflux IV-V). Cases of bilateral VUR were graded by the higher grade of reflux detected. A total of 46 children with primary VUR were followed. Among these patients, VUR was completely resolved in 16 children. Voiding cystourethrography(VCUG) and DMSA scan were performed every year. Values for urinary markers were estimated every year.
Results
: 24 or 12 hour urine microalbumin and NAG excretions were significantly increased in group III compared to group I(microalbumin : 27.7±26.0 mg/gCr vs 15.0±10.7 mg/gCr, P<0.05, NAG : 15.2±18.7 U/gCr vs 3.4±2.2 U/gCr, P<0.05). Urinary β2 MG excretions were not significantly different between groups. Urinary NAG excretions were elevated in the group of children with severe VUR compared to mild VUR(26.8±27.1 U/gCr vs 7.6±3.8 U/gCr, P<0.05). After resolution of VUR, urinary microalbumin and NAG excretions were decreased(P<0.05).
Conclusion
: Urinary microalbumin and NAG may be useful clinical indicators to predict the presence of reflux nephropathy and the resolution of VUR. Especially, urinary NAG excretions may be used as a possible method to predict the severity of VUR.
Key Words: β2 microglobulin(β2 MG), Microalbumin, N-acetyl-β-D-glucosaminidase(NAG), Urinary tract infections, Vesicoureteral reflux, Renal scarring


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