Role of proteinuria, hypertension, inflammation and predictive value of cystatin C in development of reflux nephropathy in children with vesicoureteral reflux

Aim: To investigate the role of proteinuria, hypertension, inflammation and predictive value of cystatin C in development of reflux nephropathy in children with vesicoureteral reflux.Material-Methods: This prospective study was designed in 93 patients following with a diagnosis of vesicoureteral reflux in Pediatric Nephrology Department of Cukurova University Hospital between the years of 2009 and 2011.Demographic data of the patients were recorded. Blood and timely urine samples were taken. Complete blood count, blood and urine chemistry, erithrocyte sedimentation rate, C-reactive protein, procalcitonin, Interleukin-18 and cystatin C were all analysed. Glomerular filtration rates were calculated according to Schwartz, Hoek and Larsson formulas and also creatinine clearence. Ambulatory blood pressure monitorization was applied to whole patients and z scores were calculated with LMS method.The patients were divided into two groups according to presence of microalbuminuria. Statistical analyses was done.Results: Incidence of scarring and antihypertensive medication and level of serum BUN, creatinine were higher whereas glomerular filtration rates calculated with both of four formulas were lower in microalbuminuric patients. Cystatin C based formulas might be an alternative of Scwartz and creatinine clearence. 24 hour systolic and diastolic; night systolic and 24 hour, day and night mean arteriel pressures were higher in these patients. Other parameters were not statistically significant.Conclusion: Existence of proteinuria increases the severity of scarring, hypertension particularily mean arterial pressure and also decreases glomerular filtration rates. Cystatin C might be a useful marker for predicting renal function and prognosis. Cystatin-C based GFR formulas might be an alternative for Schwartz and creatinine clearence. Erithrocyte sedimentation rate, C-reactive protein, procalcitonin, Interleukin-18 might not have a good predictive value in reflux nephropathy. Follow-up of high risk patients with proteinuria, cystatin C and ambulatory blood pressure monitorization seem to be reasonable.