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Obstructed Versus Dilated Nonobstructed Kidneys in Children With Congenital Ureteropelvic Junction Narrowing: Role of Urinary Tubular Enzymes

Authors
Journal
The Journal of Urology
0022-5347
Publisher
Elsevier
Publication Date
Volume
178
Issue
2
Identifiers
DOI: 10.1016/j.juro.2007.04.006
Keywords
  • Ureteral Obstruction
  • Acetylglucosaminidase
  • Alkaline Phosphatase
  • Gamma-Glutamyltransferase
  • Pediatrics
Disciplines
  • Biology

Abstract

Purpose We evaluated the role of voided urine lysosomal enzyme N-acetyl-β-D-glucosaminidase and brush border enzymes alkaline phosphatase and γ-glutamyl transferase in differentiating between children with ureteropelvic junction obstruction in need of pyeloplasty and those with dilated nonobstructed kidneys suitable for conservative treatment. Materials and Methods The study included 35 children with unilateral ureteropelvic junction obstruction treated with pyeloplasty (study group) and 15 children with dilated nonobstructed kidneys who were treated conservatively and followed for 15 months (control group). Voided urine samples were obtained before treatment from both groups, and from the study group at 1, 2, 3, 6, 9 and 12 months postoperatively and the control group at 3, 9 and 15 months of followup. N-acetyl-β-D-glucosaminidase, alkaline phosphatase and γ-glutamyl transferase were measured in urine samples collected from both groups. Results In the study group the activities of preoperative urinary N-acetyl-β-D-glucosaminidase, alkaline phosphatase and γ-glutamyl transferase were significantly higher than in the control group. A cutoff value of 7.8 mU/mg creatinine N-acetyl-β-D-glucosaminidase yielded a sensitivity of 97.1%, a specificity of 80% and an overall accuracy of 92%. A cutoff value of 34.5 IU/gm creatinine alkaline phosphatase resulted in a sensitivity of 91.4%, a specificity of 100% and an overall accuracy of 94%. A cutoff value of 54 IU/gm creatinine γ-glutamyl transferase yielded a sensitivity of 62.9%, a specificity of 100% and an overall accuracy of 74%. The combination of urinary N-acetyl-β-D-glucosaminidase and alkaline phosphatase resulted in a sensitivity of 100%, a specificity of 80% and an overall accuracy of 94%. Compared to preoperative activities, N-acetyl-β-D-glucosaminidase, alkaline phosphatase and γ-glutamyl transferase decreased significantly at 12 months after pyeloplasty in the study group. Conclusions Voided urinary N-acetyl-β-D-glucosaminidase, alkaline phosphatase and γ-glutamyl transferase are accurate markers for differentiating between children with ureteropelvic junction obstruction requiring pyeloplasty and those with dilated nonobstructed kidneys suitable for conservative treatment. Measurement of these enzymes in voided urine could be used as a noninvasive tool for long-term followup of children with ureteropelvic junction obstruction after pyeloplasty and those receiving conservative treatment.

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