In:
PLOS ONE, Public Library of Science (PLoS), Vol. 17, No. 7 ( 2022-7-14), p. e0270018-
Abstract:
Extracellular matrix proteins and enzymes involved in degradation have been found to be associated with tissue fibrosis and ureteropelvic junction obstruction (UPJO). In this study we developed a promising urinary biomarker model which can identify reduced renal function in UPJ obstruction patients. This can potentially serve as a non-invasive way to enhance surgical decision making for patients and urologists. Objective We sought to develop a predictive model to identify UPJO patients at risk for reduced renal function. Design Prospective cohort study Setting Pre-operative urine samples were collected in a prospectively enrolled UPJO biomarker registry at our institution. Urinary MMP-2, MMP-7, TIMP-2, and NGAL were measured as well as clinical characteristics including hydronephrosis grade, differential renal function, t 1/2 , and UPJO etiology. Participants Children who underwent pyeloplasty for UPJO Main outcome measurement Primary outcome was reduced renal function defined as MAG3 function 〈 40%. Multivariable logistic regression was applied to identify the independent predictive biomarkers in the original Training cohort. Model validation and generalizability were evaluated in a new UPJO Testing cohort. Results We included 71 patients with UPJO in the original training cohort and 39 in the validation cohort. Median age was 3.3 years (70% male). By univariate analysis, reduced renal function was associated with higher MMP-2 (p = 0.064), MMP-7 (p = 0.047), NGAL (p = 0.001), and lower TIMP-2 (p = 0.033). Combining MMP-7 with TIMP-2, the multivariable logistic regression model predicted reduced renal function with good performance (AUC = 0.830; 95% CI: 0.722–0.938). The independent testing dataset validated the results with good predictive performance (AUC = 0.738). Conclusions and relevance Combination of urinary MMP-7 and TIMP-2 can identify reduced renal function in UPJO patients. With the high sensitivity cutoffs, patients can be categorized into high risk (aggressive management) versus lower risk (observation).
Type of Medium:
Online Resource
ISSN:
1932-6203
DOI:
10.1371/journal.pone.0270018
DOI:
10.1371/journal.pone.0270018.g001
DOI:
10.1371/journal.pone.0270018.t001
DOI:
10.1371/journal.pone.0270018.t002
DOI:
10.1371/journal.pone.0270018.t003
DOI:
10.1371/journal.pone.0270018.s001
DOI:
10.1371/journal.pone.0270018.s002
DOI:
10.1371/journal.pone.0270018.s003
Language:
English
Publisher:
Public Library of Science (PLoS)
Publication Date:
2022
detail.hit.zdb_id:
2267670-3
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