The Utility of Noninvasive Urinary Biomarkers for the Evaluation of Vesicoureteral Reflux in Children

“Our results encourage further studies to evaluate LL-37, IL-6, and NGAL as noninvasive urinary markers that can improve the management of patients with VUR. Moreover, these urinary biomarkers may become alternative assessment tools to VCUG and DMSA scans. According to our study, urinary NGAL and LL-37 can be useful in differentiating severe from mild VUR. Thus, it could be easier to identify patients who require antibiotic prophylaxis or surgical intervention.”

“All these aspects would increase patient comfort and reduce the costs related to hospitalizations and investigations. Also, due to the prognostic value of these markers in diagnosing RS and RN, it may be easier to identify patients at risk of developing CKD, allowing prompt therapeutic intervention that would improve clinical outcomes.”

“For the diagnosis of VUR, we used the medical records and voiding cystourethrogram (VCUG). The VCUG is the gold standard investigation for the diagnosis of VUR and consists of bladder catheterization with the inoculation of a contrast agent, followed by a radiological examination. The VCUG allows the diagnosis of VUR, staging, and description of the anatomy of the urinary tract, and is also indicated for tracking the evolution of VUR.”

“Urinary IL-6, NGAL, and LL-37 could serve as valuable markers for diagnosing and predicting outcomes in patients with VUR and RN. These biomarkers could help to identify the severity of kidney injury in children with VUR. Based on our results and similar ones previously published, future prospective studies will be able to establish the role of these markers in the early detection of patients at risk for unfavorable evolution.”

“Moreover, these noninvasive and easy-to-determine urinary markers can facilitate the monitoring of evolution, replacing invasive and laborious examinations, such as the VCUG. Besides the diagnostic and prognostic potential, the markers studied by us can influence the clinical management of patients with VUR. They could be used to distinguish patients who require surgical intervention from those who can be managed with prophylactic antibiotic therapy or those who can be only followed up clinically."