Affiliations: Department of Paediatrics and Nephrology, Medical
University of Białystok, Białystok, Poland | Department of Rheumatology and Internal Medicine,
Medical University of Białystok, Białystok, Poland
Note: [] Corresponding author: Agata Korzeniecka-Kozerska, Medical
University of Białystok, Department of Paediatrics and Nephrology,
15-274 Bialystok, 17 Waszyngtona Street, Poland. Tel.: +48 85 7450-663; Fax:
+48 85 7421-838; E-mail: agatakozerska@poczta.onet.pl
Abstract: BACKGROUND: The study was undertaken to develop a potential new
markers for distinguishing minimal change nephrotic syndrome (MCNS) and focal
segmental glomerulosclerosis (FSGS) in children. We hypothesized that matrix
metalloproteinase-9/neutrophil gelatinase-associated lipocalin (MMP-9/NGAL) is
a better marker of focal sclerosis in the glomerulus then matrix
metalloproteinase-9/tissue inhibitor of metalloproteinase-1 (MMP-9/TIMP-1) and
matrix metalloproteinase-2/tissue inhibitor of metalloproteinase-2 MMP2/TIMP-2.
METHODS: The present study used a sample of 36 children and
adolescents subdivided into two groups: I – 20 children with MCNS,
subjected to examination twice: A – in relapse of nephrotic syndrome,
before treatment and B – after regression of proteinuria; II – 16
children with FSGS. MMPs and TIMPs and NGAL levels were measured in the urine
using ELISA kit. MMP-9/TIMP-1, MMP-2/TIMP-2 and MMP-9/NGAL ratios were
calculated. RESULTS: Median NGAL/cr. was significantly higher in MCNS and FSGS
patients when compared to healthy controls. Both, NGAL and MMP-9 urinary levels
were significantly elevated in FSGS subjects, as compared with control
subjects. Contrary to FSGS children, in MCNS group, before treatment only
NGAL/cr., but not MMP-9/cr. was increased. Urinary concentrations of NGAL and
MMP-9 were highly associated with each other (NGAL/cr. vs. MMP-9/cr., r=0.485,
p<0.01). Median urine MMP-9/NGAL ratio in FSGS patients was significantly
higher than in patients with MCNS. We also found that significant increase in
MMP-9/NGAL was associated with FSGS [odds ratio (OR) – 9.0; confidence
interval (CI) 1.97–41.07]. CONCLUSION: MMP-9/NGAL ratio may serve as differentiation marker
between MCNS and FSGS in nephrotic children.
