Vesicoureteral reflux (VUR) – a dynamic obstructive uropathy, which is a leader in the structure of children's urological diseases. Recurrent urinary tract infections in case of VUR, even when defects progress is erased and asymptomatic leads to severe complications.

In 115 patients with VUR aged 9 months to 14 years before endovesical defects correction and six months after intervention were determined non-invasive markers of kidney parenchyma damage – excretion in urine microalbumin (MA), creatinine (Cr), glycosaminoglycans (GAGs) and transforming growth factor β1 (TGF-β1). Among surveyed unilateral defect slightly prevailed over bilateral – 63 (54,78 %) to 52 (45,22 %). Almost half of the patients were children under 3 years of age – 52 (45,22 %). The largest group consisted of patients with VUR III grade – 49 (42,61 %). A bit fewer patients were with II grade – 39 (33,91 %) and the smallest with the IV grade of defect – 27 (23,48 %).

The survey was conducted before endovesical correction of VUR and six months after surgery. The comparison with corresponding indicators performed in 24 healthy children. All patients with VUR II-IV grades, at the stage of clinical-laboratory remission restored urodynamics using endovesical treatment. The criterion for successful completion of the endoscopic treatment VUR considered complete and effective closure ureteral orifice, which controlled via hydrodistention of the orifice and distal ureter.

In patients with VUR diagnosed disturbances of urine marker excretion involving renal parenchyma glomerular apparatus: MA – 23,83 mg/l (14,85; 31,41), Cr – 0,65 g/l (0,44; 0,86) and nephrosclerosis markers: GAGs – 307,7 CPC units per gram of creatinine (278,6; 342,3) and profibrogenic cytokine TGF-β1 – 29,57 pg/ml (27,25; 32,56). Six months after endovesical VUR correction in patients noticed decrease of urinary levels MA – 23,83 mg/l (14,85; 31,41), GAGs – 307,7 CPC units per gram of creatinine (278,6; 342,3) and TGF-β1 – 29,57 pg/ml (27,25; 32,56) and Cr increase – 0.65 g/l (0,44; 0,86).

Six months after mini-invasive treatment of VUR indicators GAGs, TGF-β1 and Cr in urine for bilateral form were moderately worse than in case of unilateral. An exception was only MA level in urine, which for unilateral VUR was slightly higher.

Patients who recovered, the level of MA, GAGs and TGF-β1 in urine characterized by decrease and Cr increase and therefore the approach to that of healthy children. But in patients in which the grade of VUR decreased or remained, revealed an increase of MA, GAGs and TGF-β1 in urine and only Cr held at preoperative period.

The results confirm the thesis that children with violation of urodynamics in case of VUR fast enough leads to renal parenchyma damage and progression of nephrosclerosis. Accordingly, it is advisable to correct VUR at an early age by using endovesical techniques. For monitoring progress of the process and the effectiveness of the treatment can offer highly informative non-invasive markers of early kidney parenchyma damage – excretion in urine MA, Cr, GAGs and TGF-β1.

Miniinvasive VUR correction reduces the intensity of tubular and glomerular dysfunction and deceleration processes sclerosis renal parenchyma in postoperative period. Normalization of these indices in the VUR indicates the effectiveness endovesical timely intervention.

Received 07/11/16

Keywords: vesicoureteral reflux, kidney function, non-invasive markers, children

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