Research ArticleKidney Disease

Fetal Urinary Peptides to Predict Postnatal Outcome of Renal Disease in Fetuses with Posterior Urethral Valves (PUV)

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Science Translational Medicine  14 Aug 2013:
Vol. 5, Issue 198, pp. 198ra106
DOI: 10.1126/scitranslmed.3005807

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Seeking a Signature of Renal Disease

Being able to predict—in utero—whether a fetus will have severe kidney disease would help anxious parents make informed treatment decisions earlier. To this end, Klein and colleagues searched through thousands of peptides in fetal urine to find potential markers of end-stage renal disease (ESRD).

The authors obtained urine samples from fetuses with posterior urethral valves (PUV), which is an abnormality of the urinary tract that can lead to ESRD. They knew the outcome of these patients with PUV, that is, whether or not they had ESRD before the age of 2. Out of >4000 peptides, Klein et al. identified a handful that were linked to ESRD, but were not present in the fetal urine of patients who did not progress to ESRD. In an independent set of samples, this peptide-based signature, called 12PUV, was similarly able to predict postnatal renal function, outperforming routine clinical procedures such as ultrasound and biochemical tests. Although many more fetal urine samples are needed for validation, this peptide-based predictor shows promise as a much needed test to help clinicians and families make prenatal treatment decisions for fetuses with PUV.

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