High-grade vesicoureteric reflux (VUR) promotes the development of renal nephropathy (RN) due to scar formation. This process involves transforming growth factor beta-1 (TGF beta(1)), which stimulates production of the extracellular matrix proteins, including laminin (LN). The aim of the study was to assess LN and TGF beta(1) concentration according to VUR grade. The study group (1) consisted of 54 patients aged 6.23 +/- 4.15 years with VUR, including: A, 19 with grade II; B, 19 with grade III; and C, 16 with grades IV or V reflux. The control group (2) contained 27 healthy patients aged 6.76 +/- 4.02 years. LN and total TGF beta(1) concentrations in serum and urine were determined by the immunoenzymatic (EIA) method. To assess total serum TGF beta(1) levels, we used a solid-phase enzyme-linked immunosorbent assay (ELISA). Both serum and urinary levels of LN and TGF beta(1) in VUR patients were higher compared with controls (p < 0.05). The highest urinary concentration of LN and TGF beta(1) was found in subgroup C. A positive correlation was noted between urinary TGF beta(1) and LN. Increased TGF-beta(1) and LN levels in urine of high-grade VUR children suggests a potential role in fibrogenesis. Further trials are needed to investigate the role of serum and urinary LN level in VUR children.

The study objective was to assess serum and urine fibronectin (FN) levels in children with vesicoureteral reflux (VUR) depending on reflux grade and urine osmolality. The study group (1) consisted of 54 VUR children, median age 4.28 (range 0.6-15) years: subgroup A, 19 children with grade II; subgroup B, 19 with grade III; and subgroup C, 16 with grade IV or V VUR. The control group (2) included 27 healthy children. The immunoenzymatic method enzyme immunoassay (EIA) was used to determine serum soluble and urine FN levels, with an osmometer to measure urinary osmolality. The median urine FN in VUR children was 224.1 (15.4-3537) ng/mg creatinine (Cr), compared with the control group: 137.9 (20.3-670.6) ng/mg Cr (p<0.05), whereas median serum FN was 395.0 (13.0-779.9) ng/ml and 121.9 (25-345.1) ng/ml (p<0.05), respectively. A detailed analysis showed that only in subgroup C was the level of urinary FN significantly higher than in the control group (p<0.01). However, serum concentration was elevated in all VUR children (A-C) compared with controls (p<0.01). Reduced osmolality, below 800 mOsm/kg H2O, was observed in subgroup C. Negative correlation between urinary osmolality and urinary FN was found (r=-0.426, p < 0.01). In children with VUR, serum FN increased with reflux grade, whereas its urinary level was elevated only in grade IV and V reflux with impaired urine concentration.