title: Urinary MMP-9/NGAL ratio as a potential marker of FSGS in nephrotic children.
abstract: BACKGROUND
  The study was undertaken to develop a potential new markers for distinguishing minimal change nephrotic syndrome (MCNS) and focal segmental glomerulosclerosis (FSGS) in children. We hypothesized that matrix metalloproteinase-9/neutrophil gelatinase-associated lipocalin (MMP-9/NGAL) is a better marker of focal sclerosis in the glomerulus then matrix metalloproteinase-9/tissue inhibitor of metalloproteinase-1 (MMP-9/TIMP-1) and matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-2 MMP2/TIMP-2.
  
  
  METHODS
  The present study used a sample of 36 children and adolescents subdivided into two groups: I - 20 children with MCNS, subjected to examination twice: A - in relapse of nephrotic syndrome, before treatment and B - after regression of proteinuria; II - 16 children with FSGS. MMPs and TIMPs and NGAL levels were measured in the urine using ELISA kit. MMP-9/TIMP-1, MMP-2/TIMP-2 and MMP-9/NGAL ratios were calculated.
  
  
  RESULTS
  Median NGAL/cr. was significantly higher in MCNS and FSGS patients when compared to healthy controls. Both, NGAL and MMP-9 urinary levels were significantly elevated in FSGS subjects, as compared with control subjects. Contrary to FSGS children, in MCNS group, before treatment only NGAL/cr., but not MMP-9/cr. was increased. Urinary concentrations of NGAL and MMP-9 were highly associated with each other (NGAL/cr. vs. MMP-9/cr., r=0.485, p<0.01). Median urine MMP-9/NGAL ratio in FSGS patients was significantly higher than in patients with MCNS. We also found that significant increase in MMP-9/NGAL was associated with FSGS [odds ratio (OR) - 9.0; confidence interval (CI) 1.97-41.07].
  
  
  CONCLUSIONS
  MMP-9/NGAL ratio may serve as differentiation marker between MCNS and FSGS in nephrotic children.
authors.affiliation: Department of Paediatrics and Nephrology, Medical University of Białystok, Białystok, Poland. agatakozerska@poczta.onet.pl
authors.forename: Agata
authors.initials: A
authors.lastname: Korzeniecka-Kozerska
authors.forename: Anna
authors.initials: A
authors.lastname: Wasilewska
authors.forename: Edyta
authors.initials: E
authors.lastname: Tenderenda
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Sulik
authors.forename: Kamil
authors.initials: K
authors.lastname: Cybulski
mesh_terms: D000209:Acute-Phase Proteins / Q000652:urine*; D000293:Adolescent; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D005923:Glomerulosclerosis, Focal Segmental / Q000175:diagnosis* / Q000652:urine; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000652:urine*; D008297:Male; D020778:Matrix Metalloproteinase 2 / Q000652:urine; D020780:Matrix Metalloproteinase 9 / Q000652:urine*; D009404:Nephrotic Syndrome / Q000175:diagnosis* / Q000652:urine; D011518:Proto-Oncogene Proteins / Q000652:urine*; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000652:urine; D019716:Tissue Inhibitor of Metalloproteinase-2 / Q000652:urine
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; C560822:TIMP1 protein, human; C560823:TIMP2 protein, human; D019715:Tissue Inhibitor of Metalloproteinase-1; D019716:Tissue Inhibitor of Metalloproteinase-2; C522361:MMP2 protein, human; D020778:Matrix Metalloproteinase 2; C579270:MMP9 protein, human; D020780:Matrix Metalloproteinase 9