title: Urinary excretion of EGF and MCP-1 in children with vesicoureteral reflux.
abstract: OBJECTIVE
  The aim of this study was to investigate the urinary concentration of epidermal growth factor (EGF) and monocyte chemotactic protein-1 (MCP-1) as reflux nephropathy (RN) biomarkers before and after endoscopic treatment of moderate to severe vesico-ureteral reflux (VUR).
  
  
  METHODS
  A prospective study was carried out on 72 children with moderate to severe VUR. All patients underwent endoscopic treatment using Macroplastique ® or Deflux®. Vesico-ureteral reflux resolution was tested by post-operative voiding cystourethrography after 3 months and 2 years. Follow-up urinary samples were collected at that time. Control samples were taken from healthy children with no clinical evidence of renal and bladder disease and no history of UTI.
  
  
  RESULTS
  In VUR patients, pre-operative urinary EGF levels had a down-regulation when compared to controls. Following successful VUR repair, urinary EGF levels of VUR children progressively increased only at long term follow-up but without returning to normal levels. Urinary MCP-1 levels were highly expressed in pre-operative samples and decreased markedly during early post-operative measurements. Urinary MCP-1 levels did not further decreased in late post-operative follow-up. In fact, these levels remained significantly higher when compared to controls.
  
  
  CONCLUSIONS
  Urinary levels of EGF and MCP-1 may become useful markers for monitoring the response to surgical treatment in VUR patients. Although endoscopic VUR treatment is effective in reducing the inflammatory response, the persistence of significant abnormal levels of inflammatory cytokines (such as urinary MCP-1) at long term follow-up suggests that surgery alone may not completely treat the chronic renal inflammation evidenced in these children.
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Pastore
authors.affiliation: Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bartoli
mesh_terms: D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D018932:Chemokine CCL2 / Q000652:urine*; D002648:Child; D002675:Child, Preschool; D004815:Epidermal Growth Factor / Q000652:urine*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000601:surgery / Q000652:urine*
chemical_list: D015415:Biomarkers; C111835:CCL2 protein, human; D018932:Chemokine CCL2; D004815:Epidermal Growth Factor
keywords: EGF Family of Proteins; Urinary Tract; Vesico-Ureteral Reflux