Pd55-05 the Use of Urinary Biomarkers to Identify True Ureteropelvic Junction Obstruction in Hydronephrotic Pediatric Patients

You have accessJournal of UrologyPediatrics VI (PD55)1 May 2024PD55-05 THE USE OF URINARY BIOMARKERS TO IDENTIFY TRUE URETEROPELVIC JUNCTION OBSTRUCTION IN HYDRONEPHROTIC PEDIATRIC PATIENTS Shao Y. Tao, Tianjia J. Ge, Rachelle B. Balili, James D. Brooks, and Kunj R. Sheth Shao Y. TaoShao Y. Tao , Tianjia J. GeTianjia J. Ge , Rachelle B. BaliliRachelle B. Balili , James D. BrooksJames D. Brooks , and Kunj R. ShethKunj R. Sheth View All Author Informationhttps://doi.org/10.1097/01.JU.0001008908.82706.9f.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In pediatric patients presenting with hydronephrosis, it is challenging to distinguish true ureteropelvic junction obstruction (UPJO) from non-obstructive dilation (NOD) with ultrasound alone. While renography can provide clues to an obstructive voiding pattern and delineate differential renal function (DRF), it is invasive. Thus, there is a need for a non-invasive metric to accurately predict UPJO. We aim to assess the use of urine biomarkers in evaluating patients with unilateral hydronephrosis. METHODS: This IRB-approved study enrolled hydronephrotic patients (n=81) and healthy controls (n=14), excluding those with bilateral high-grade hydronephrosis, chronic renal disease, or immunosuppressant medication. Enrolled hydronephrotic patients were subcategorized as UPJO and NOD, based on progression to pyeloplasty. Urine samples were analyzed for Neutrophil Gelatinase-Associated Lipocalin (NGAL), Human Carbohydrate Antigen 19-9 (HCA19-9), Interferon-Gamma Inducible Protein 10 kDa (IP10), and Monocyte Chemoattractant Protein 1 (MCP1) by enzyme-linked immunosorbent assay (ELISA). Statistical analyses (t-tests and logistic regression) were conducted using Prism Version 10.1. RESULTS: UPJO patients (n=35) exhibited significantly higher levels of NGAL, HCA19-9, and IP10 when compared to NOD patients (n=46) (Table 1). Furthermore, patients with decreased DRF had significantly higher NGAL and HCA19-9. Utilizing all urinary biomarker levels, our logistic regression model demonstrated a sensitivity of 94.29% and an area under the curve of 0.91 (95% confidence interval: 0.84-0.98, p<0.0001). In younger patients, ages 0-3, patients with UPJO (n=9) exhibited significantly higher HCA19-9 and IP10 levels when compared to neonates with NOD (n=17). CONCLUSIONS: To date, the current study is the largest pediatric series evaluating urinary biomarkers in patients presenting with unilateral hydronephrosis. Elevated biomarker levels correlated with the presence of UPJO and declined DRF. The logistic regression model distinguished between UPJO and NOD with high sensitivity and accuracy. Next steps will include longitudinal prognostic studies of the urinary biomarkers specifically in patients presenting with an incidental diagnosis of unilateral hydronephrosis. Source of Funding: Pediatric Urology Innovation Research Award Laboratory Startup Funding © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1152 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Shao Y. Tao More articles by this author Tianjia J. Ge More articles by this author Rachelle B. Balili More articles by this author James D. Brooks More articles by this author Kunj R. Sheth More articles by this author Expand All Advertisement PDF downloadLoading ...