DOI: 10.4103/jiaps.jiaps_204_23 ISSN: 0971-9261

Comparison of Urinary Biomarkers in Diagnosis of Ureteropelvic Junction Obstruction and Differentiation from Nonobstructive Dilatation

Sangeetha Geminiganesan, Ashwin Raj Kumar, S. Kumaravel, C. D. Mohana Priya, Sathyamurthy Arunaa, Ramesh Babu
  • Surgery
  • Pediatrics, Perinatology and Child Health
Show PDF Cite

A
BSTRACT

Background and Aims:

Differentiation of nonobstructive dilatation (NOD) from ureteropelvic junction obstruction (UPJO) is a challenge in children with antenatally detected hydronephrosis. The aim of this study is to compare the utility of urinary biomarkers: carbohydrate antigen (CA 19-9), neutrophil gelatinase-associated lipocalin (NGAL), and kidney injury molecule (KIM) in diagnosing UPJO.

Methods:

A prospective study was conducted after obtaining ethical clearance between 2021 and 2022. Group 1 – control group (n = 30): children with normal antenatal ultrasound with no urinary symptoms. Group 2 – study group (n = 48): children with unilateral hydronephrosis: Group 2a – NOD (n = 24): children stable on ultrasound and diuretic renogram and Group 2b – UPJO (n = 24): children who worsened to Grade 4 hydronephrosis on ultrasound/worsening of differential renal function (10% drop) on renogram who underwent pyeloplasty. Urinary biomarkers NGAL, KIM-1, and CA 19-9 were measured using the enzyme-linked immune absorbent assay method.

Results:

The urine CA 19-9 level was 128.05 ± 4.08 U/mL in the UPJO group, and this was significantly higher (P = 0.001) than NOD, 70.29 ± 4.41, and controls, 1.91 ± 1.57. The urine NGAL level was 21.41 ± 4.44 pg/mL in UPJO, and this was significantly higher than controls, 2.669 ± 0.513, but not NOD, 24.55 ± 2.67. The urine KIM level was 817 ± 15.84 pg/mL in the UPJO group, and this was significantly higher than controls, 285 ± 8.10, but not NOD, 768.23 ± 15.12. Receiver operating characteristic analysis of CA 19-9 revealed a urine biomarker cutoff of 95 U/mL for diagnosing UPJO (sensitivity 95%; specificity 96%; and area under the curve 0.99).

Conclusions:

CA 19-9 is a superior marker compared to NGAL and KIM in differentiating UPJO from NOD. Further studies with larger numbers are warranted.

More from our Archive