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TIMP‐2 as a noninvasive urinary marker for predicting neurogenic bladder in patients under follow‐up for spina bifida
Author(s) -
Nayak Shubhalaxmi,
Bawa Monika,
Kanojia Ravi P.,
Pal Arnab,
Jain Anu,
Samujh Ram
Publication year - 2021
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24528
Subject(s) - medicine , urinary system , urine , urology , urinary bladder , pathogenesis , spina bifida , prospective cohort study , group b , nephrology , gastroenterology , surgery
Neurogenic bladder (NB) post‐meningomyelocele (MMC) repair is a major challenge and needs lifelong follow‐up. Many cytokines have been implicated in the pathogenesis of NB. To avoid repeated urodynamic studies (UDS) and renal scans, we studied urinary tissue inhibitors of metalloproteinases‐2 (TIMP‐2) levels and correlated with urodynamic profiles to establish their efficacy. Materials and Methods Prospective case–control study on children between 6 months to 12 years of age, who were at least 6 months post‐MMC repair and had NB on UDS. Patients were evaluated under 4 cohorts of 20 patients each: Group A (NB on treatment), Group B (NB not on treatment), Group C (no NB), and Group D (Controls). All groups underwent radiofrequency thermocoagulation, urine culture, ultrasonography. Urine samples were stored at −8°C and analyzed using a validated Human ELISA kit for TIMP‐2. Results Eighty patients with a mean age of 3.54 ± 2.1 years were studied. A common ultrasound finding was a thickened urinary bladder (33.3%). All UDS parameters showed a statistically significant differences between groups with NB (Groups A and B) and a group without NB (Group C). Analysis of TIMP‐2 levels between individual groups was statistically significant. The area under the receiver operating characteristic curve between urinary TIMP‐2 and cystometric parameters indicated that urinary TIMP‐2 levels are highly diagnostic of NB. TIMP‐2 value of 358.5 pg/ml was found to be the least value with 93.5 sensitivity and 86.2% specificity. Conclusion This study highlights the potential of urinary marker TIMP‐2 as noninvasive and cost‐effective test to initially diagnose and predict the progression of disease in NBs with reasonable sensitivity and specificity.