Evaluation of Caspase 3 Enzyme and TNF-alpha as Biomarkers in Ureteropelvic Junction Obstruction in Children- a preliminary report.

Ali Eslahi,Mehdi Shirazi ,Sharifi ,Farzaneh Rahimi ,Ali Reza Safarpour

doi:10.12669/pjms.332.11934

Abstract

Objective:To determine the applicability of urinary caspase 3 enzyme and TNF-α as biomarkers in children with ureteropelvic junction obstruction (UPJO).Methods:In this study, 31 unilateral UPJO patients and 33 age- and sex-matched healthy childrens were enrolled. The patients with UPJO consisted of 11 female and 20 male children between the ages of 2 to 62 months old. All participants were evaluated regarding anterior-posterior(AP) diameter and cortical thickness of affected kidney by ultrasonography. Technetium DTPA renal scan and voiding cystourethrogram(to assess vesicoureteral reflux) were performed, pre-operatively. Also, urinary levels of TNF-α and caspase 3 enzyme were checked. Follow-ups included measurement of aforementioned indices in patients: AP diameter and cortical thickness of the affected kidney, as well as TNF-α and caspase 3 levels in urine, three and six months after pyeloplasty.Results:The results showed highly significant decrease in urinary TNF-α and caspase 3 enzyme (P values < 0.01), approaching the level measured in children without UPJO after six months. Significant decrease in AP diameter and increase in cortical thickness were also noticed (P values < 0.01).Conclusion:The results of this study strongly support that TNF-α and caspase 3 levels in urine can be used for improvement monitoring in follow-up of UPJO patients after pyeloplasty and can also be potentially used as determining indices for surgical plan but more studies, especially in patients who are not surgical candidates are needed to confirm our observaitons.

Highlights

Ureteropelvic junction obstruction (UPJO) is considered as a morbidity of upper urinary tract, withCorrespondence: November 18, 2016 December 17, 2016 February 15, 2017 February 28, 2017 physiologic or structural etiologies, which leads to hydronephrosis of the affected kidney and is the main cause of congenital obstructive nephropathy.[1]
Prolonged obstruction eventually leads to progressive loss of nephrons with renal tubular atrophy and interstitial fibrosis.[4]
Criteria for pyeloplasty consisted of differential function less than 40% which is evaluated by isotopic studies, AP diameter of renal pelvis greater than 20mm and failure of conservative management leading to more than 10% loss of renal function

Summary

Introduction

Correspondence: November 18, 2016 December 17, 2016 February 15, 2017 February 28, 2017 physiologic or structural etiologies, which leads to hydronephrosis of the affected kidney and is the main cause of congenital obstructive nephropathy.[1] Manifestations can vary from being asymptomatic to presenting with signs and symptoms like recurrent urinary tract infections, renal stones and pain.[2] With the help of prenatal screening ultrasonography, hydronephrosis is detected with a prevalence of 0.5% to 1%.3,4. Prolonged obstruction eventually leads to progressive loss of nephrons with renal tubular atrophy and interstitial fibrosis.[4]

Methods

Results

Conclusion