Oxidative stress products and antioxidant levels in patients with vesicouretheral reflux

Vesicoureteral reflux (VUR) is one of the important urological problems during the childhood. The most important long-term complication of the VUR is the "reflux nephropathy" which has got the renal parenchymal scar formation and the deterioration of the renal functions, and it is an important cause of the hypertension and the renal failure among children, as well. It has been shown that the reflux nephropathy was responsible for the 5-12% of the renal failure‟s causes in developed countries. In regard to renal destruction, we need to have adequate and effective methods in order to quick results and to prevent any complications to occur, among children with VUR. Children with VUR are always being exposed to radioactive x-rays during the scintigraphic evaluations performed to understand for the existence and to follow-up of the scars especially, for the babies who were detected to have antenatal hydronephrosis, since scintigraphic evaluations are limited and it is impossible to perform them infrequent manners to follow up, we need to have alternative and another useful methods which could be replaced by scintigraphic exam. There are two different mechanisms which play role in renal scar formation in patients with VUR. These are the infection and the ischemia-reperfusion damage. In different studies searching for the mechanisms of the scar formation, it has been proved that MPO and MDA has a role a scar formation developing due to infections. On the other hand, MPO, MDA, XO, GSH, and SOD levels were also effective. Researchers about the damage occurring due to ischemia-reperfusion in other organs have showed that MPO, MDA, XO, GSH and SOD levels were the effectors. In this clinical prospective study, our aim is to show if serum oxidant and antioxidant substance levels could be used for follow up and treatment of the children with VUR. For this purpose, serum specimens of 80 patients were collected between June 2013 and June 2014. Patients were divided into five groups according to their degree of reflux, each group was consist of 16 patients. We considered as parameters included average of ages, age division between genders, whether the patients already have had scars and hypertension. Complete urine analysis, urine culture, USG, VCUG, Tc99M DMSA tests were done and MPO, XO, SOD, GSH and MDA levels as the parameters were measured from the serum specimens in all patients. We investigated the levels of the oxidative stress products and the antioxidants and development of renal parenchymal damage due to reflux nephropathy. We compared them to the dispersion of renal scar levels which were obtain from the DMSA scintigraphic exam and development of hypertension in patients with reflux. All results were analyzed by using SPSS 17 computer statistic program. MDA, MPO and XO levels were increased and SOD, GSH levels were decreased because of development of infection and ischemia-reperfusion damage after reflux. By analyzing the reflux levels and the oxidant and antioxidant levels, we found that patients with high degree of reflux have got an increase in MPO, MDA, SOD levels and a decrease in XO and GSH levels. Furthermore, by investigating the oxidant and antioxidant levels of the patients with renal scar and hypertension, we found that SOD, GSH levels were decreased and XO levels were increased in patients with high degree of reflux.