Abstract
INTRODUCTION AND OBJECTIVE: Assessment of renal function is important in determining the treatment of hydronephrosis.Various biomarkers have been used to overcome these shortcomings and to diagnose renal damage due to ureteropelvic junction obstruction early.We evaluated the usefulness of urine N-acetyl glucosaminidase (NAG) to determine the prognosis of congenital hydronephrosis. METHODS: From January to December 2018, retrospective study was performed on patients with grade 3 or 4 of hydronephrosis due to ureteropelvic junction (UPJ) obstruction. Twenty patients were enrolled except those with bilateral grade 3 or higher of hydronephrosis and other urinary abnormalities such as single kidney confirmed vesicoureteral reflux, and duplex system.We analyzed and compared the ultrasonographic findings and the ratio of NAG to creatinine in the urine between operation group and active surveillance group. The results of preoperative examination in children who underwent operation and those in the most severe results in children with active surveillance were analyzed. RESULTS: 10 children underwent laparoscopic pyeloplasty for UPJ obstruction and 10 children underwent active surveillance. The mean age at the time of examination was 3.7 (1.7-7.5) months in the operation group and 5.2 (0.5-21.5) months in the active surveillance group (P = 0.564).On the other hand, the mean AP diameter in the ultrasound group was 30 (15-49) mm in the operation group and 16.7 (9-31.3) mm active surveillance group (P = 0.003). The mean renal parenchymal thickness was 2.6 (1.2-3.7) mm in the operation group and 3.8 (2.9-5.5) mm in the active surveillance group (P = 0.017). The urinary NAG/Cr ratio was 26.1 (9.8-47.4) IU/g in the operation group and 11.1 (2.6-18.1) IU/g in the active surveillance group (P = 0.003).In the follow-up of mean 7 months after laparoscopic pyeloplasty, urinary NAG/Cr ratio was significantly reduced to 10.4 (3.4-14.2) IU/g (P = 0.023). CONCLUSIONS: One of the biomarkers of acute renal injury, urinary NAG/Cr ratio, was closely related to the degree of hydronephrosis. Therefore, it may be useful to determine the operation of the UPJ obstruction and to predict the prognosis.Source of Funding: None
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