Urine neutrophil gelatinase-associated lipocalin (NGAL) measurement is not predictive for ureteral patency in pediatric patients following pyeloplasty: a pilot study
Objective: To evaluate the benefit of urine neutrophil gelatinase-associated lipocalin (NGAL) measurement to predict the ureteral patency in pediatric patients undergoing pyeloplasty.
Materials and Methods: Ureteropelvic junction obstruction patients who underwent unilateral dismembered pyeloplasty had urine NGAL measurements taken intraoperatively during pyeloplasty and postoperatively at six months following surgery. All patients were evaluated preoperatively and postoperatively with renal scans. Pairwise comparisons and correlation analyses were performed to determine the dynamics and benefits of urine NGAL measurement.
Results: Thirteen patients were included in this pilot study with a mean age of 3.2 years at surgery. Mean intraoperative bladder urine level was 4.43 ng/mL, and median intraoperative renal pelvic urine NGAL level was 3.70 ng/mL. There was no significant difference between these two levels (p-value = 0.76). Six months after pyeloplasty, 9/13 patients demonstrated significant reduction in the bladder urine NGAL level (at least 50% reduction), and 5/13 patients showed ureteral patency based on postoperative renal scan (more than 5% improvement in differential renal function or the conversion of diuretic half time. However, the finding of significant reduction of urine NGAL level did not correlate with ureteral patency (r = -0.50, p-value = 0.08).
Conclusion: Although bladder urine NGAL level reduces in most pediatric patients following pyeloplasty, this decline is not reflective of the finding of ureteral patency from renal scanning. The benefits of urine NGAL measurement in this context remain unclear and require further large-scale investigation.
Vemulakonda V, Yiee J, Wilcox DT. Prenatal hydronephrosis: postnatal evaluation and management. Curr Urol Rep 2014;15:430.
Chevalier RL. Congenital urinary tract obstruction: the long view. Adv Chronic Kidney Dis 2015;22:312- 9.
Nguyen HT, Herndon CD, Cooper C, Gatti J, Kirsch A, Kokorowski P, et al. The Society for Fetal Urology consensus statement on the evaluation and management of antenatal hydronephrosis. J Pediatr Urol 2010;6:212-31.
Chertin B, Pollack A, Koulikov D, Rabinowitz R, Hain D, Hadas-Halpren I, et al. Conservative treatment of ureteropelvic junction obstruction in children with antenatal diagnosis of hydronephrosis: lessons learned after 16 years of follow-up. Eur Urol 2006;49:734-8.
Cheng HL. Surgical indications for unilateral neonatal hydronephrosis in considering ureteropelvic junction obstruction. Urol Sci 2014;25:73-6.
Notley RG, Beaugie JM. The long-term follow-up of Anderson-Hynes pyeloplasty for hydronephrosis. Br J Urol 1973;45:464-7.
Jenjitranant P, Viseshsindh W, Kochakarn W. Is open pyeloplasty still the first choice of operation for ureteropelvic junction obstruction in children? Thai J Urol 2020;41:15-8.
Srithong S, Usawachintachit M, Bunyaratavej C. The optimal length of follow up after successful pediatric pyeloplasty. Thai J Urol 2019;40:29-34.
Niemczyk P, Krisch EB, Zeiger L, Marmar JL. Use of diuretic renogram in evaluation of patients before and after endopyelotomy. Urology 1999;53:271-5.
Kajbafzadeh AM, Elmi A, Talab SS, Emami H, Esfahani SA, Saeedi P. Urinary and serum carbohydrate antigen 19-9 as a biomarker in ureteropelvic junction obstruction in children. J Urol 2010;183:2353-60.
Wasilewska A, Taranta-Janusz K, Debek W, Zoch-Zwierz W, Kuroczycka-Saniutycz E. KIM-1 and NGAL: new markers of obstructive nephropathy. Pediatr Nephrol 2011;26:579-86.
Madsen MG, Norregaard R, Palmfeldt J, Olsen LH, Frokiaer J, Jorgensen TM. Urinary NGAL, cystatin C, beta2-microglobulin, and osteopontin significance in hydronephrotic children. Pediatr Nephrol 2012;27:2099-106.
Streem SB. Ureteropelvic junction obstruction. Open operative intervention. Urol Clin North Am 1998;25:331-41.
Matsumoto F, Shimada K, Kawagoe M, Matsui F, Nagahara A. Delayed decrease in differential renal function after successful pyeloplasty in children with unilateral antenatally detected hydronephrosis. Int J Urol 2007;14:488-90.
Cost NG, Prieto JC, Wilcox DT. Screening ultrasound in follow-up after pediatric pyeloplasty. Urology 2010;76:175-9.
Fernandez-Ibieta M, Nortes-Cano L, Guirao-Pinera MJ, Zambudio-Carmona G, Ruiz-Jimenez JI. Radiation-free monitoring in the long-term follow-up of pyeloplasty: Are ultrasound new parameters good enough to evaluate a successful procedure? J Pediatr Urol 2016;12:230.e1-7.
Lee D, Link RE. Recurrent symptoms following pyeloplasty with a normal endoscopic evaluation: assessment and outcomes of a challenging patient cohort. Urology 2014;84:227-31.
Mettler FA, Jr., Huda W, Yoshizumi TT, Mahesh M. Effective doses in radiology and diagnostic nuclear medicine: a catalog. Radiology. 2008;248:254-63.
Papachristou F, Pavlaki A, Printza N. Urinary and serum biomarkers in ureteropelvic junction obstruction: a systematic review. Biomarkers. 2014;19:531-40.
Cost NG, Noh PH, Devarajan P, Ivancic V, Reddy PP, Minevich E, et al. Urinary NGAL levels correlate with differential renal function in patients with ureteropelvic junction obstruction undergoing pyeloplasty. J Urol 2013;190:1462-7.
Flower DR. The lipocalin protein family: structure and function. Biochem J 1996;318(Pt 1):1-14.
Mishra J, Ma Q, Prada A, Mitsnefes M, Zahedi K, Yang J, et al. Identification of neutrophil gelatinase-associated lipocalin as a novel early urinary biomarker for ischemic renal injury. J Am Soc Nephrol 2003;14:2534-43.
Srisawat N, Praditpornsilpa K, Patarakul K, Techapornrung M, Daraswang T, Sukmark T, et al. Neutrophil Gelatinase Associated Lipocalin (NGAL) in Leptospirosis Acute Kidney Injury: A Multicenter Study in Thailand. PLoS One 2015;10:e0143367.
Schmidt-Ott KM, Mori K, Li JY, Kalandadze A, Cohen DJ, Devarajan P, et al. Dual action of neutrophil gelatinase-associated lipocalin. J Am Soc Nephrol 2007;18:407-13.
McAleer IM, Kaplan GW. Renal function before and after pyeloplasty: does it improve? J Urol 1999; 162(Pt 2):1041-4.
Helmersson-Karlqvist J, Arnlov J, Larsson A. Day-to-day variation of urinary NGAL and rational for creatinine correction. Clin Biochem 2013;46:70-2.
Copyright (c) 2021 Insight Urology
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.