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Postolache L, Parsa A, Simoni P, Boitsios G, Ismaili K, Schurmans T, Monier A, Casimir G, Albert A, Parsa CF. Widespread kidney anomalies in children with Down syndrome. Pediatr Nephrol 2022; 37:2361-2368. [PMID: 35118542 DOI: 10.1007/s00467-022-05455-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rare autopsy studies have described smaller kidneys as well as urinary tract anomalies in Down syndrome. This observation has never been investigated in vivo and little is known about the possible consequences upon kidney function. Here we wish to confirm whether children with Down syndrome have smaller kidneys and to evaluate their kidney function in vivo. METHODS This retrospective cohort study enrolled 49 children with Down syndrome, as well as 49 age- and sex-matched controls at the Queen Fabiola Children's University Hospital in Brussels, Belgium. Doppler and kidney ultrasonography, spot urine albumin to creatinine ratio, estimated glomerular filtration rate (eGFR), and anthropometric data were recorded. RESULTS Kidney size in children with Down syndrome was smaller than age- and sex-matched controls in terms of length (p < 0.001) and volume (p < 0.001). Kidney function based on eGFR was also decreased in Down syndrome compared to historical normal. Twenty-one of the children with Down syndrome (42%) had eGFR < 90 mL/min/1.73 m2, with 5 of these (10%) having an eGFR < 75 mL/min/1.73 m2. In addition, 7 of the children with Down syndrome (14%) had anomalies of the kidney and/or urinary tract that had previously been undiagnosed. CONCLUSIONS Children with Down syndrome have significantly smaller kidneys than age-matched controls as well as evidence of decreased kidney function. These findings, in addition to well-noted increased kidney and urologic anomalies, highlight the need for universal anatomical and functional assessment of all individuals with Down syndrome. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Lavinia Postolache
- Department of Ophthalmology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Afshin Parsa
- The Division of Kidney, Urologic, and Hematologic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Paolo Simoni
- Department of Radiology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Grammatina Boitsios
- Department of Radiology, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Khalid Ismaili
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Thierry Schurmans
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Anne Monier
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Georges Casimir
- Department of Pediatrics, Queen Fabiola Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Adelin Albert
- Department of Biostatistics, Liège University Hospital, Liège, Belgium
| | - Cameron F Parsa
- Department of Ophthalmology, Erasmus Hospital, Université Libre de Bruxelles, 808 Route de Lennik, B-1070, Brussels, Belgium. .,Faculty of Medicine, Sorbonne University, Paris, France.
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KARA Ö, ABDULLAZADE S, USLUBAŞ AK, ERTOY BAYDAR D, TEKGÜL S. Ağır Skarlı Böbreklerin Üreter Alt Uç Patolojik Özellikleri Az Skarlı Tarafla Karşılaştırıldığında Belirgin Farklılık Göstermektedir. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.641286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Tokhmafshan F, Brophy PD, Gbadegesin RA, Gupta IR. Vesicoureteral reflux and the extracellular matrix connection. Pediatr Nephrol 2017; 32:565-576. [PMID: 27139901 PMCID: PMC5376290 DOI: 10.1007/s00467-016-3386-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/24/2022]
Abstract
Primary vesicoureteral reflux (VUR) is a common pediatric condition due to a developmental defect in the ureterovesical junction. The prevalence of VUR among individuals with connective tissue disorders, as well as the importance of the ureter and bladder wall musculature for the anti-reflux mechanism, suggest that defects in the extracellular matrix (ECM) within the ureterovesical junction may result in VUR. This review will discuss the function of the smooth muscle and its supporting ECM microenvironment with respect to VUR, and explore the association of VUR with mutations in ECM-related genes.
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Affiliation(s)
| | - Patrick D. Brophy
- Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Rasheed A. Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA,Center for Human Genetics, Duke University Medical Center, Durham, NC 27710, USA
| | - Indra R. Gupta
- Department of Human Genetics, McGill University, Montreal, QC, Canada,Department of Pediatrics, McGill University, Montreal, QC, Canada
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Arena S, Iacona R, Impellizzeri P, Russo T, Marseglia L, Gitto E, Romeo C. Physiopathology of vesico-ureteral reflux. Ital J Pediatr 2016; 42:103. [PMID: 27899160 PMCID: PMC5129198 DOI: 10.1186/s13052-016-0316-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 11/26/2016] [Indexed: 01/13/2023] Open
Abstract
Vescico-Ureteral Reflux (VUR) is a common condition in childhood, caused by a congenital anomaly at the Vescico-Ureteral Junction (VUJ) level. It seems that the main cause could be an abnormal embryological development occurred during the early stage of fetal life. Refluxing ureteral endings show structural and functional anomalies: previous studies have shown a significant decrease in alfa actin, miosin and desmin contents as well as an high rate of atrophy and muscular degeneration with disorganized muscular fibres. The roles played by Cajal cells and Connexin 43 in generating peristaltic waves appears to be fundamental for the physiological VUJ function and activity. Attention was focused also on the congenital muscular deficiency of the RUs, on regard to general morphology, smooth muscle cells architecture, inflammatory markers and the distribution of collagen composition. This review will discuss and investigate the importance of the modified configuration of Sarcoglycan (SG) sub complex (particularly the deficiency of the ε-SG and the increased expression of the α-SG), the role played by Cajal Cells, the intravescical tunnel length to ureteral diameter ratio as possible causes of the functional alterations in the refluxing ureteral ends leading towards the VUJ incompetence.
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Affiliation(s)
- Salvatore Arena
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatric Surgery, University of Messina, 98125, Messina, Italy.
| | - Roberta Iacona
- Unit of pediatric Surgery, Oxford University Hospital, Oxford, UK
| | - Pietro Impellizzeri
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatric Surgery, University of Messina, 98125, Messina, Italy
| | - Tiziana Russo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatric Surgery, University of Messina, 98125, Messina, Italy
| | - Lucia Marseglia
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatrics, University of Messina, Messina, 98125, Italy
| | - Eloisa Gitto
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatrics, University of Messina, Messina, 98125, Italy
| | - Carmelo Romeo
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi" - Unit of Paediatric Surgery, University of Messina, 98125, Messina, Italy
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Liu J, Sun L, Shen Q, Wu X, Xu H. New congenital anomalies of the kidney and urinary tract and outcomes in Robo2 mutant mice with the inserted piggyBac transposon. BMC Nephrol 2016; 17:98. [PMID: 27460642 PMCID: PMC4962383 DOI: 10.1186/s12882-016-0308-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 07/19/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Disruption of ROBO2 in humans causes vesicoureteral reflux (VUR)/congenital anomalies of the kidney and urinary tract (CAKUT). PiggyBac (PB) is a DNA transposon, and its insertion often reduces-but does not eliminate-gene expression. The Robo2 insertion mutant exhibited non-dilating VUR, ureteropelvic junction obstruction (UPJO) not found in reported models. We studied the incidence and outcomes of VUR/CAKUT in this mutant and explored the relationship between Robo2 gene expression and the occurrence and severity of VUR/CAKUT. METHODS The urinary systems of newborn mutants were evaluated via Vevo 770 micro-ultrasound. Some of the normal animals-and all of the abnormal animals-were followed to adulthood and tested for VUR. Urinary obstruction experiments were performed on mice with hydronephrosis. The histology of the kidney and ureter was examined by light microscopy and transmission electron microscopy. Robo2 (PB/PB) mice were crossed with Hoxb7/myr-Venus mice to visualize the location of the ureters relative to the bladder. RESULTS In Robo2 (PB/PB) mice, PB insertion led to an approximately 50 % decrease in Robo2 gene expression. The most common (27.07 %, 62/229) abnormality was non-dilating VUR, and no statistically significant differences were found between age groups. Approximately 6.97 % displayed ultrasound-detectable CAKUT, and these mice survived to adulthood without improvement. No severe CAKUT were found in Robo2 (PB/+) mice. The refluxing ureters showed disorganized smooth muscle fibers, reduced muscle cell populations, intercellular edema and intracytoplasmic vacuoles in smooth muscle cells. Both UPJ and UVJ muscle defects were noted in Robo2 (PB/PB) mice. CONCLUSIONS Robo2 (PB/PB) mice is the first Robo2-deficient mouse model to survive to adulthood while displaying non-dilating VUR, UPJO, and multiple ureters with blind endings. The genetic background of these mutants may influence the penetrance and severity of the CAKUT phenotypes. VUR and other CAKUT found in this mutant had little chance of spontaneous resolution, and this requires careful follow-up. We reported for the first time that the non-dilated refluxing ureters showed disorganized smooth muscle fibers and altered smooth muscle cell structure, more accurately mimicking the characteristics of human cases. Future studies are required to test the role of Robo2 in the ureteric smooth muscle.
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Affiliation(s)
- Jialu Liu
- Department of Nephrology and Rheumatism, Children's Hospital of Fudan University, 399 WanYuan Road, Shanghai, 201102, China
| | - Li Sun
- Department of Nephrology and Rheumatism, Children's Hospital of Fudan University, 399 WanYuan Road, Shanghai, 201102, China
| | - Qian Shen
- Department of Nephrology and Rheumatism, Children's Hospital of Fudan University, 399 WanYuan Road, Shanghai, 201102, China
| | - Xiaohui Wu
- State Key Laboratory of Genetic Engineering and National Center for International Research of Development and Disease, Institute of Developmental Biology and Molecular Medicine, Collaborative Innovation Center for Genetics and Development, School of Life Sciences, Fudan University, Shanghai, 200433, China
| | - Hong Xu
- Department of Nephrology and Rheumatism, Children's Hospital of Fudan University, 399 WanYuan Road, Shanghai, 201102, China.
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The significance of Pax2 expression in the ureter epithelium of children with vesicoureteric reflux. Hum Pathol 2015; 46:963-70. [DOI: 10.1016/j.humpath.2015.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 01/05/2015] [Accepted: 01/08/2015] [Indexed: 11/19/2022]
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Izol V, Acikalin AA, Kuyucu Y, Deger M, Aridogan IA, Polat S, Satar N. Ultrastructural and immunohistopathological evaluation of intravesical ureters via electron and light microscopy in children with vesicoureteral reflux. J Urol 2013; 191:1110-7. [PMID: 24126283 DOI: 10.1016/j.juro.2013.10.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE We used immunohistochemical methods and transmission electron microscopy to investigate the cytokine profiles and ultrastructural changes in the ureterovesical junction of children with primary vesicoureteral reflux. MATERIALS AND METHODS A total of 39 distal intravesical ureters were obtained from 23 children who underwent ureteroneocystostomy for primary vesicoureteral reflux. Ureteral wall smooth muscle organization and transforming growth factor-β1, vascular endothelial growth factor and CD34 were evaluated immunohistochemically and compared to controls, which consisted of 10 age matched autopsy specimens. Ultrastructural evaluations and morphological descriptions were performed semiquantitatively and compared to the published data. RESULTS Of the patients 6 (26%) were male and 17 (74%) were female, and mean ± SD age was 73.2 ± 34.3 months (range 12 to 168). There was no correlation between reflux grade and age (p = 0.39). Smooth muscle disorganization score differed significantly between patients with intravesical ureters and controls (p = 0.01). Transforming growth factor-β1 levels were significantly higher (p = 0.001) and vascular endothelial growth factor levels and microvessel densities were significantly lower in the patients with reflux compared to controls (both p <0.001). Vascular endothelial growth factor, CD34 and transforming growth factor-β1 levels did not correlate with reflux grades (p = 0.84, p = 0.76 and p = 0.10, respectively). Urothelium, lamina propria and tunica adventitia appeared normal in the specimens for all grades of vesicoureteral reflux using transmission electron microscopy. Damage was observed in the muscular layers of the ureterovesical junction, especially in patients with grade IV or V reflux. CONCLUSIONS Primary refluxing ureters exhibit immunohistopathological abnormalities compared to normal ureters irrespective of reflux grade, and ultrastructural changes are especially severe in cases of high grade reflux. These abnormalities can hinder the normal ureteral valve mechanism, and may lead to reflux due to smooth muscle dysfunction and microvascular alterations.
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Affiliation(s)
- Volkan Izol
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Arbil Avci Acikalin
- Department of Pathology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Yurdun Kuyucu
- Department of Histology and Embryology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Mutlu Deger
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | | | - Sait Polat
- Department of Histology and Embryology, Faculty of Medicine, University of Çukurova, Adana, Turkey
| | - Nihat Satar
- Department of Urology, Faculty of Medicine, University of Çukurova, Adana, Turkey
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Carpenter A, Paulus A, Robinson M, Bates CM, Robinson ML, Hains D, Kline D, McHugh KM. 3-Dimensional morphometric analysis of murine bladder development and dysmorphogenesis. Dev Dyn 2012; 241:522-33. [PMID: 22275180 DOI: 10.1002/dvdy.23744] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2012] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Disorders of the urinary tract represent a major cause of morbidity and impaired quality of life. To better understand the morphological events responsible for normal urinary tract development, we performed 3-D reconstructive analysis of developing mouse bladders in control, mgb-/-, and Fgfr2(Mes-/-) mice. RESULTS Detrusor smooth muscle differentiation initiated in the bladder dome and progressed caudally with the leading edge extending down the right posterior surface of the bladder. Gender-specific differences in detrusor smooth muscle development were observed during early embryonic development. Bladder trigone morphology transitioned from an isosceles to equilateral triangle during development due to the preferential lengthening of the urethra to ureter distance. The primary defect observed in mgb-/- bladders was a significant reduction in detrusor smooth muscle differentiation throughout development. Deviations from normal trigone morphology correlated best with VUR development in Fgfr2(Mes-/-) mice, while alterations in intravesicular tunnel length did not. CONCLUSIONS Multivariate morphometric analysis provides a powerful tool to quantify and assess urinary tract development.
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Affiliation(s)
- Ashley Carpenter
- Center for Molecular and Human Genetics, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio 43205, USA.
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Hains DS, Sims-Lucas S, Carpenter A, Saha M, Murawski I, Kish K, Gupta I, McHugh K, Bates CM. High incidence of vesicoureteral reflux in mice with Fgfr2 deletion in kidney mesenchyma. J Urol 2010; 183:2077-84. [PMID: 20303521 DOI: 10.1016/j.juro.2009.12.095] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Indexed: 11/28/2022]
Abstract
PURPOSE Mice with Fgfr2 conditional deletion in metanephric mesenchyma (Fgfr2(Mes-/-)) have ureteral bud induction abnormalities. We determined whether Fgfr2(Mes-/-) mutants developed abnormally positioned ureters predisposing to vesicoureteral reflux. MATERIALS AND METHODS We measured common nephric duct length and assayed for apoptosis in embryonic day 11.5 mice. We performed 3-dimensional reconstruction of, and real-time polymerase chain reaction and whole mount in situ hybridization for Fgfr2 in urinary tracts in embryonic day 15.5 embryos. We also performed cystograms followed by 3-dimensional reconstruction in postnatal animals. RESULTS Compared with controls Fgfr2(Mes-/-) embryos had increased common nephric duct length with no difference in apoptosis, indicating cranially displaced ureteral buds. Three-dimensional reconstruction at embryonic day 15.5 showed low ureteral insertion into the bladder near the bladder neck in Fgfr2(Mes-/-) mice. Postnatal Fgfr2(Mes-/-) mutants had a high rate of vesicoureteral reflux compared with controls (47.4% vs 4.0%, p = 0.00006). In postnatal mutants with unilateral reflux the refluxing ureters inserted closer to the bladder neck than nonrefluxing ureters. External ureteral insertional angles at the outer bladder wall formed by the ureteral insertion points and the bladder neck were greater in mutant refluxing ureters than in contralateral nonrefluxing ureters or control ureters. At embryonic day 15.5 Fgfr2 was decreased in Fgfr2(Mes-/-) kidneys compared with that in controls but not statistically different in ureters or bladders. CONCLUSIONS Fgfr2(Mes-/-) mice have ureteral induction abnormalities associated with abnormal ureteral insertion in the bladder and subsequent vesicoureteral reflux, consistent with the Mackie and Stephens hypothesis.
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Affiliation(s)
- David S Hains
- Division of Nephrology, Department of Pediatrics, Ohio State University College of Medicine, Columbus, Ohio, USA
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Diagnosing papillorenal syndrome: see the optic papilla. Pediatr Nephrol 2008; 23:1893-4. [PMID: 18512081 DOI: 10.1007/s00467-008-0870-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 04/17/2008] [Accepted: 04/18/2008] [Indexed: 10/22/2022]
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Schwentner C, Oswald J, Lunacek A, Pelzer AE, Fritsch H, Schlenck B, Karatzas A, Bartsch G, Radmayr C. Extracellular microenvironment and cytokine profile of the ureterovesical junction in children with vesicoureteral reflux. J Urol 2008; 180:694-700. [PMID: 18554644 DOI: 10.1016/j.juro.2008.04.048] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Indexed: 11/16/2022]
Abstract
PURPOSE Vesicoureteral reflux is caused by a defective valve mechanism of the ureterovesical junction. Previous studies have revealed structural and metabolic changes in the intravesical ureter, impairing its contractile properties. Smooth musculature and nerves are replaced by collagen, while matrix degrading enzymes are over expressed. We investigated the presence of regulating cytokines and the extracellular matrix composition to elucidate further the pathophysiology of vesicoureteral reflux. MATERIALS AND METHODS Ureteral endings were obtained from 28 children during antireflux surgery, and 14 age matched autopsy specimens served as controls. Routine histological sections were immunostained for insulin-like growth factor-1, nerve growth factor, transforming growth factor-beta1, tumor necrosis factor-alpha and vascular endothelial growth factor. Smooth muscle staining was supplemented by tenascin C, tetranectin and fibronectin detection. Staining patterns were investigated using computer assisted, high power field magnification analyses. RESULTS Tumor necrosis factor-alpha and transforming growth factor-beta1 were significantly more abundant in vesicoureteral reflux samples, whereas insulin-like growth factor-1, nerve growth factor and vascular endothelial growth factor were more prevalent in healthy controls. Fibronectin was intensely expressed in refluxing ureters, while it was scarce in healthy children. Tenascin C was notable within the urothelium of both groups. Only vesicoureteral reflux samples displayed tenascin C in the musculature and connective tissue. Tetranectin staining was only detected in vesicoureteral reflux. CONCLUSIONS Several cytokines are differentially expressed in primary refluxing ureters, indicating an ongoing tissue remodeling process in the ureterovesical junction region. Additionally, the smooth muscle coat is widely lacking, while extracellular matrix proteins typical for tissue shrinkage and reorganization are over expressed. These alterations are likely to contribute to the malfunctioning active ureteral valve mechanism in primary vesicoureteral reflux.
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Affiliation(s)
- C Schwentner
- Department of Pediatric Urology, Medical University Innsbruck, Innsbruck, Austria.
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Arena S, Favaloro A, Cutroneo G, Consolo A, Arena F, Anastasi G, Di Benedetto V. Sarcoglycan Subcomplex Expression in Refluxing Ureteral Endings. J Urol 2008; 179:1980-6; discussion 1986. [DOI: 10.1016/j.juro.2008.01.059] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Indexed: 10/22/2022]
Affiliation(s)
- Salvatore Arena
- Department of Pediatric Surgery, Unit of Pediatric Surgery, University of Catania, Catania, Italy
| | - Angelo Favaloro
- Departments of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Giuseppina Cutroneo
- Departments of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Angela Consolo
- Departments of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Francesco Arena
- Departments of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy
| | - Giuseppe Anastasi
- Departments of Biomorphology and Biotechnologies, University of Messina, Messina, Italy
| | - Vincenzo Di Benedetto
- Department of Pediatric Surgery, Unit of Pediatric Surgery, University of Catania, Catania, Italy
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Payabvash S, Kajbafzadeh AM, Tavangar SM, Monajemzadeh M, Sadeghi Z. Myocyte Apoptosis in Primary Obstructive Megaureters: The Role of Decreased Vascular and Neural Supply. J Urol 2007; 178:259-64; discussion 264. [PMID: 17499782 DOI: 10.1016/j.juro.2007.03.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Indexed: 01/06/2023]
Abstract
PURPOSE We compared myocyte apoptosis index, microvessel density and nerve supply as well as muscular and collagen composition in the obstructed ureteral endings of children with primary obstructive megaureter and normal controls. MATERIALS AND METHODS Tissue specimens were obtained during ureteral reimplantation in 16 patients with primary obstructive megaureter. For the control group normal ureteral endings were taken at autopsy from 19 age and sex matched children. In all specimens we determined the myocyte apoptosis index, number of CD31 positive microvessels, alpha-actin positive muscular component and number of nerve terminals. The collagen fibers were also specifically stained. RESULTS The myocyte apoptosis index was higher in obstructed vesicoureteral junctions (10.14%+/-1.03%) compared to controls (2.11%+/-0.21%, p<0.001). Mean number of vascular elements per microscopic field was lower in ureteral endings of patients with obstructive megaureter compared to controls (p<0.001). The number of nerve endings was also significantly lower in obstructed ureteral endings. There was a negative correlation between the number of microvessels and myocyte apoptosis index in both study groups. In obstructed megaureters the number of nerve endings was also negatively correlated with myocyte apoptosis index but positively correlated with the number of microvessels. In obstructed vesicoureteral junctions the proportion of muscular component was lower and the proportion of collagen fibers was higher compared to normal controls. Positive correlation was found between the myocyte apoptosis index and the percentage of collagenous component in both study groups. CONCLUSIONS Congenital defective vascular development may result in myocyte apoptosis, and reduction of neural elements and muscular components in obstructed vesicoureteral junctions. Subsequent substitution of connective tissue may lead to functional obstruction in primary obstructive megaureter.
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Affiliation(s)
- Seyedmehdi Payabvash
- Department of Urology, Pediatric Urology Research Center, Children's Hospital, and Tehran University of Medical Sciences, Tehran, Iran
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Arena S, Fazzari C, Arena F, Scuderi MG, Romeo C, Nicòtina PA, Di Benedetto V. Altered 'active' antireflux mechanism in primary vesico-ureteric reflux: a morphological and manometric study. BJU Int 2007; 100:407-12. [PMID: 17532859 DOI: 10.1111/j.1464-410x.2007.06921.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To immunolocate c-kit-positive interstitial cells of Cajal (ICCs, known to be responsible for pacemaker activity in human ureters, coordinating ureteric motility) in the intramural ureter of patients with different grades of vesico-ureteric reflux (VUR), to assess the ureteric histology and correlate these findings with manometric patterns. PATIENTS AND METHODS The VU junction (VUJ) represents the boundary between the low-pressure of the upper and high pressure of the lower urinary tract, protecting the upper tract from VUR using active and passive antireflux mechanisms. The contraction of the longitudinal muscle coat of the VUJ possibly functions as an 'active' antireflux system, but previous manometric findings on refluxing ureteric units (RUs) have shown altered patterns. In all, 32 RU ends were stained using both picro-Mallory and Sirius Red techniques; in a parallel immunohistochemical procedure, using mast cell tryptase and CD117 antibodies (to identify ICCs), they were compared with eight control ureteric ends. Ureteric manometry of the VUJ was also done during ureteric reimplantation. RESULTS The histochemical and immunohistochemical results in the RUs showed a replacement of the altered smooth muscle fascicles by collagenous stroma and significant loss of ICCs in RU ends, both correlated with the grade of VUR. Ureteric manometry showed significant impairment of basal and maximum pressure in RUs, correlated, respectively, with histological lesions and loss of ICCs. CONCLUSION Deficiency of the longitudinal muscle coat probably leads to dysfunction and insufficiency of the ostial valve mechanism, with subsequent impairment of the active valve mechanism. Histological, histochemical and immunohistochemical changes support the alterations of ureteric peristalsis in RUs.
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Affiliation(s)
- Salvatore Arena
- Unit of Paediatric Surgery and Urology, Department of Paediatric Surgery, Vittorio Emanuele Hospital, University of Catania, Catania, Italy.
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