Intraoperative urinary ACR as a prognostic biomarker in unilateral pelviureteric junction obstruction in paediatric population - An observational study.

BACKGROUND

Many urinary biomarkers like MCP1, EGF, KIM1, CCL5/RANTES, CA19.9, NAG, TTF and micro albumin have been used as indicators of renal damage in HDN patients. Urine albumin-to-creatinine ratio (ACR) is widely used to detect renal damage in systemic diseases like diabetes and hypertension. While extensively studied in medical renal diseases, its role as an intraoperative prognostic biomarker for renal damage remains unexplored. ACR offers advantages such as low cost, easy availability, and spot testing.

AIMS: To determine the correlation between urinary ACR from obstructed pelvis in the prognostication of renal function of children with unilateral pelviureteric junction obstruction.

METHODS

This prospective observational pilot study included 30 patients with unilateral PUJO, aged over six months, undergoing Anderson-Hynes pyeloplasty. Patients underwent a standardized diagnostic protocol, including USG-KUB and technetium-99m DTPA renal scans. Preoperative urinary ACR from voided urine was measured. During surgery, urine from the obstructed pelvis was aspirated for ACR analysis. Data analysis compared preoperative and postoperative variables and intra-operative urinary ACR levels were correlated with change in differential renal function on DTPA.

DISCUSSION: Postoperative outcomes currently rely on dynamic nuclear renal scans and USG performed 3 months after surgery. Intraoperative urinary ACR from the obstructed renal pelvis shows promise as an early biomarker for predicting renal function outcomes after pyeloplasty. It provides immediate results, alleviating parental anxiety by eliminating the usual delay in postoperative assessments.

CONCLUSION

This study highlights the potential role of urinary ACR for peri-operative prognostication in children with PUJO, though larger studies are required to confirm these findings.

LEVEL OF EVIDENCE: Level 2B - Prospective observational study.