title: Is urinary kidney injury molecule-1 a noninvasive marker for renal scarring in children with vesicoureteral reflux?
abstract: OBJECTIVE
  To examine whether (1) levels of urinary kidney injury molecule-1 (KIM-1), a transmembrane protein and biomarker for renal tubular damage, increase in children with of vesicoureteral reflux (VUR), and (2) if KIM-1 predicts the grade of renal scarring in children with VUR.
  
  
  METHODS
  The study included 59 VUR patients with renal scarring, 5 VUR patients without renal scarring and 25 healthy controls aged 1 to 17 years. Dimercaptosuccinic acid scans were performed for determination of scarring and graded by 3 independent, blinded pediatric urologists for renal scarring according to the Randomized Intervention for Children with VUR study criteria. Spot urine samples were obtained. Urinary KIM-1 and creatinine levels were measured and the KIM-1/creatinine ratio was calculated.
  
  
  RESULTS
  Urine geometric mean KIM-1 levels (ng/mg creatinine) were significantly higher in VUR patients than in healthy controls (P=.018). Although the correlation between VUR grade and geometric mean KIM-1 levels was not significant, a positive correlation was found for scarring grade and geometric mean KIM-1 levels (r=.30, P=.02). When the patients were divided by subgroups according to scarring grade (group I, grade 1; group II, grades 2 and 3; group III, grade 4), the log KIM-1 in group III was significantly higher than in group I (P=.004).
  
  
  CONCLUSIONS
  Urinary KIM-1 levels might be used as a noninvasive marker, particularly in showing severe scarring in children with VUR.
authors.affiliation: Department of Biochemistry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey. aysuntoker@gmail.com
authors.forename: Aysun
authors.initials: A
authors.lastname: Toker
authors.forename: Tevfik
authors.initials: T
authors.lastname: Ziypak
authors.forename: Ebru
authors.initials: E
authors.lastname: Orsal
authors.forename: Esra
authors.initials: E
authors.lastname: Laloglu
authors.forename: Fevzi
authors.initials: F
authors.lastname: Bedir
authors.forename: Yilmaz
authors.initials: Y
authors.lastname: Aksoy
mesh_terms: D000704:Analysis of Variance; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D002614:Chelating Agents; D002648:Child; D002675:Child, Preschool; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology / Q000652:urine*; D005260:Female; D000072596:Hepatitis A Virus Cellular Receptor 1; D006801:Humans; D007684:Kidney Tubules / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008562:Membrane Glycoproteins / Q000652:urine*; D011868:Radioisotopes; D011877:Radionuclide Imaging; D011991:Receptors, Virus; D012720:Severity of Illness Index; D012737:Sex Factors; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D004113:Succimer; D013667:Technetium; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000652:urine*
chemical_list: D015415:Biomarkers; D002614:Chelating Agents; C491143:HAVCR1 protein, human; D000072596:Hepatitis A Virus Cellular Receptor 1; D008562:Membrane Glycoproteins; D011868:Radioisotopes; D011991:Receptors, Virus; D013667:Technetium; D004113:Succimer