FETAL URINARY INSULIN-LIKE GROWTH-FACTOR-I AND BINDING-PROTEIN-3 IN BILATERAL OBSTRUCTIVE UROPATHIES

Fetal urinary concentrations of insulin-like growth factor I (UIGF-I) and binding protein 3 (UIGFBP-3) were determined in patients with pren atal diagnosis of bilateral obstructive uropathy. Patients were retros pectively assigned to three groups, on the basis of outcome: group 1,: termination of pregnancies (n=11) with sonographic evidence of severe oligohydramnios or renal dysplasia, confirmed at histological examina tion; group 2, patients (n=10) with postnatal plasma creatinine >50 mu mol/l at the age of 1 year (1 yr-pCreat); and group 3, patients (n=16 ) with 1 yr-pCreat less than or equal to mu mol/l. The results show a significant increase in UIGF-I and UIGFBP-3 in groups 1 (18 159 +/- 90 83 pg/ml; 2657 +/- 669 ng/ml) and 2 (1574 +/- 847 pg/ml; 176 +/- 50 ng /ml) in comparison with group 3 (35 +/- 6 pg/ml; 21 +/- 2 ng/ml). UIGF -I and UIGFBP-3 were significantly correlated with postnatal plasma cr eatinine, and were both sensitive (90 per cent; 80 per cent) and speci fic (88 per cent: 88 per cent) for prediction of elevated 1 yr-pCreat (>50 mu mol/l). Fetal urinary IGF-I and IGFBP-3 are increased in sever e fetal bilateral obstructive uropathy, possibly reflecting tubular dy sfunction or/and increased synthesis consequent upon fetal kidney inju ry. Their predictive value for postnatal renal function needs further assessment.