Elevated bladder urine concentration of transforming growth factor-beta 1 correlates with upper urinary tract obstruction in children

Purpose: We evaluated urinary transforming growth factor-beta 1 (TGF-beta 1 ) concentration in children with upper urinary tract obstruction as a poten tial tool for supporting the diagnosis of clinically significant obstructio n. Materials and Methods: Renal pelvic and bladder urine samples were obtained for analysis. From 30 patients a median of 5 months old who underwent surg ery for obstruction at the ureteropelvic (29) and ureterovesical (1) juncti ons. Urinary TGF-beta 1 concentration was measured using a quantitative san dwich enzyme-linked immunoassay technique. Bladder urine TGF-beta 1 in pati ents with obstruction was compared with that in controls. In addition, we c ompared renal pelvic and bladder urine TGF-beta 1 in patients with obstruct ion. Results: Mean bladder urine TGF-beta 1 plus or minus standard error of mean was 4-fold higher in patients with upper tract obstruction than in control s (195 +/- 29 versus 47 +/- 7 pg./mg. creatinine, p <0.001). In the obstruc ted group mean TGF-beta 1 in the renal pelvic urine was 378 +/- 86 pg./mg. creatinine, or twice that of the bladder urine (p = 0.02). Conclusions: Bladder urine TGF-beta 1 in patients with upper urinary tract obstruction is significantly elevated compared with that in controls. To ou r knowledge our study is the first to identify a bladder urinary marker tha t correlates with upper urinary tract obstruction with greater than 90% sen sitivity. Measuring TGF-beta 1 in a voided bladder urine sample may provide an objective and noninvasive test for assisting in the diagnosis of upper urinary tract obstruction.