Pediatric UrologyRole of Urinary Tubular Enzymes in Evaluation of Children With Ureteropelvic Junction Narrowing Under Conservative Management
Section snippets
Material and Methods
The study group included 30 children (22 boys and 8 girls) with a diagnosis of unilateral UPJ narrowing. Their mean age ± SEM was 5 ± 0.68 years (range 9 months to 12 years). All patients were diagnosed as having unilateral dilated nonobstructed kidneys due to UPJ narrowing as documented by nonobstructed washout renographic curve and a half-time drainage of <10 minutes with split renal function >40% on diuretic renography.5 Moreover, the children had no symptoms or signs suggestive of renal
Results
The consecutive evaluation of GFR and split renal function of the corresponding kidneys during conservative management revealed stabilization in 15 patients (50%) and deterioration in 15 patients (50%). The deterioration of renal function was observed at 3 months in 5 patients, 9 months in 7, and 15 months in 3 patients. All patients with renal deterioration were considered obstructed and immediately underwent pyeloplasty. The 15 patients with stabilization of renal function were considered to
Comment
The major clinical challenges of evaluating and treating patients with obstructive nephropathy relate to the indications for, and timing of, surgical intervention and establishing prognostic indicators for progression.12 The identification of suitable biomarkers of renal injury resulting from urinary tract obstruction would be useful in tracking the progression of the disorder and in monitoring the response to new therapies.13
Urinary enzymes originate in the kidneys, and many of them can be
Conclusions
The renal tubular enzymes NAG, ALP and GGT are noninvasive biomarkers that could be used in the long-term follow-up of children with UPJ narrowing under conservative management to identify those children who might develop obstruction and need surgical correction.
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