The use of biomarkers in the diagnosis and treatment of obstruction of the upper urinary tract in children.

Zuzana Seifriedova,Zuzana Seifriedova,Oldrich Smakal,Jan Sarapatka,Vladimir Student,Hana Flogelova

doi:10.5507/bp.2022.002

Abstract

Antenatal hydronephrosis, dilatation of the upper urinary tract (UUTD), is a common finding on prenatal ultrasound. One of the most common causes is ureteropelvic junction (UPJ) obstruction. Although such prenatally diagnosed UUTD resolves spontaneously in most newborns, further examination of these children is advocated to prevent possible irreversible kidney damage, and ultrasound is mainly used for this. If the dilatation persists or becomes symptomatic, it is necessary to proceed to other relatively demanding and invasive diagnostic examinations for these small patients, where the question of the right timing of indications for possible surgical solutions is still unclear. For this reason, various biomarkers have been investigated in a number of clinical trials as potential mini-invasive diagnostic tools for determining when upper urinary tract dilatation in such children poses a threat to the developing kidneys and they should be operated on, and vice versa, when to proceed conservatively. The aim of this article is to review the findings on and current issues with the use of biomarkers in the diagnosis and treatment of UPJ obstruction in children.

Highlights

Antenatal hydronephrosis with ureteropelvic junction (UPJ) obstruction is a congenital malformation associated with a restriction in the outflow of urine, which is defined according to the European Association of Urology Guidelines as an impaired outflow of urine from the renal pelvis to the proximal ureter with subsequent dilatation of the renal drainage system and risk of renal impairment1.Unilateral obstruction can lead to progressive deterioration of renal function in 20–40% of cases, according to available studies
Antenatal hydronephrosis with UPJ obstruction is a congenital malformation associated with a restriction in the outflow of urine, which is defined according to the European Association of Urology Guidelines as an impaired outflow of urine from the renal pelvis to the proximal ureter with subsequent dilatation of the renal drainage system and risk of renal impairment1
Cases that are not detected through prenatal screening are most often postnatally manifested by urinary tract infections, failure to thrive, or pain. In most neonates, such prenatally diagnosed upper urinary tract dilatation (UUTD) resolves spontaneously, there is a significant number of cases in which the ultrasound deteriorates, and there is a high risk of progression to permanent loss of renal function

Summary

INTRODUCTION

Antenatal hydronephrosis with UPJ obstruction is a congenital malformation associated with a restriction in the outflow of urine, which is defined according to the European Association of Urology Guidelines as an impaired outflow of urine from the renal pelvis to the proximal ureter with subsequent dilatation of the renal drainage system and risk of renal impairment. Included in this review article are studies that examined biomarkers in urine samples in children under 18 years of age with unilateral or bilateral evidence of UPJ obstruction compared to healthy children (control group) and/ or children with dilatation of the renal collecting system without obstruction (conservatively treated group). A difference in NGAL levels was found in urine collected perioperatively from the renal pelvis in patients with UPJ obstruction compared to "bladder" NGAL in patients as well as NGAL levels in healthy children when determined from urinated urine This was subsequently confirmed in a study by Cost et al.. TGFβ1 levels measured in urine were significantly elevated before surgery in operated children with UPJ obstruction compared to a healthy control group.

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Findings

CONCLUSIONS