Urinary Levels of the Renal Tubular Enzyme N-Acetyl- β -D-Glucosaminidase in Unilateral Obstructive Uropathy
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No AccessJournal of Urology1 Feb 1994Urinary Levels of the Renal Tubular Enzyme N-Acetyl-β-D-Glucosaminidase in Unilateral Obstructive Uropathy Michael C. Carr, Craig A. Peters, Alan B. Retik, and James Mandell Michael C. CarrMichael C. Carr , Craig A. PetersCraig A. Peters , Alan B. RetikAlan B. Retik , and James MandellJames Mandell View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)34983-2AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Elevated urinary levels of the renal tubular enzyme, N-acetyl-ß-D-glucosaminidase (NAG), have been shown to be associated with reversible tubular damage and, therefore, may serve as an indicator of tubular damage in the setting of presumed obstruction uropathy. This study compares urinary NAG levels in children with apparent upper tract obstruction with normal children to assess the sensitivity of this assay for the detection of possible renal tubular damage. The study included 40 children 3 weeks to 16 years old with unilateral ureteropelvic junction obstruction (30) or primary obstructive megaureter (10). Urine was obtained from the bladder in all children and from the renal pelvis or ureter in 30 patients at surgery. Pelvic and ureteral urinary NAG levels were consistently higher than bladder levels. In patients with ureteropelvic junction obstruction NAG levels were 7 times higher than normal (76 units per mg., p <0.0001) and 3 times higher than normal in patients with obstructive megaureter (29 units per mg., p <0.001). The mean bladder urinary NAG levels in patients with ureteropelvic junction obstruction (17.6 units per mg. creatinine, standard error of mean 2.01, p <0.001) and megaureters (19.2 units per mg. creatinine, standard error of mean 3.6, p <0.049) were elevated above control patients (10.6 units per mg. creatinine, standard error of mean 1.02). Elevated urinary NAG levels in the renal pelvis, ureter and bladder may be helpful in identifying upper tract obstruction, which if left untreated, might cause progressive renal deterioration. © 1994 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byTaha M, Shokeir A, Osman H, Abd El-Aziz A and Farahat S (2007) Obstructed Versus Dilated Nonobstructed Kidneys in Children With Congenital Ureteropelvic Junction Narrowing: Role of Urinary Tubular EnzymesJournal of Urology, VOL. 178, NO. 2, (640-646), Online publication date: 1-Aug-2007.CHEVALIER R (2018) BIOMARKERS OF CONGENITAL OBSTRUCTIVE NEPHROPATHY: PAST, PRESENT AND FUTUREJournal of Urology, VOL. 172, NO. 3, (852-857), Online publication date: 1-Sep-2004.FURNESS P, MAIZELS M, HAN S, COHN R and CHENG E (2018) ELEVATED BLADDER URINE CONCENTRATION OF TRANSFORMING GROWTH FACTOR-beta 1 CORRELATES WITH UPPER URINARY TRACT OBSTRUCTION IN CHILDRENJournal of Urology, VOL. 162, NO. 3 Part 2, (1033-1036), Online publication date: 1-Sep-1999.Fung L and Atala A (2018) CONSTANT ELEVATION IN RENAL PELVIC PRESSURE INDUCES AN INCREASE IN URINARY N-ACETYL-beta-D-GLUCOSAMINIDASE IN A NONOBSTRUCTIVE PORCINE MODELJournal of Urology, VOL. 159, NO. 1, (212-216), Online publication date: 1-Jan-1998.Edelstein R, Bauer S, Kelly M, Darbey M, Peters C, Atala A, Mandell J, Colodny A and Retik A (2018) Long-Term Urological Response of Neonates With Myelodysplasia Treated Proactively With Intermittent Catheterization and Anticholinergic TherapyJournal of Urology, VOL. 154, NO. 4, (1500-1504), Online publication date: 1-Oct-1995. Volume 151Issue 2February 1994Page: 442-445 Advertisement Copyright & Permissions© 1994 by The American Urological Association Education and Research, Inc.KeywordskidneyglucosaminidaseenzymesMetricsAuthor Information Michael C. Carr Supported by the National Kidney Foundation/American Foundation for Urologic Disease Research Fellowship. More articles by this author Craig A. Peters More articles by this author Alan B. Retik More articles by this author James Mandell More articles by this author Expand All Advertisement PDF downloadLoading ...Keywords:
Obstructive uropathy
Megaureter
Renal pelvis
Upper urinary tract
Urinary tract obstruction
Obstructive uropathy
Pyonephrosis
Urinary obstruction
Urinary tract obstruction
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Obstructive uropathy refers to the clinical sequelae of impairment of free urinary flow in the urological tract. The clinical manifestation of obstructive uropathy depends on the level and duration of obstruction, whether it is partial or complete, and whether infection has supervened. Obstruction may be clinically silent—and incidental radiological, biochemical, or examination findings may suggest the diagnosis. The radiological techniques used to demonstrate obstruction can be divided into anatomical and functional studies. These include ultrasound, urography, cross-sectional imaging, micturating cystourethrography, the Whitaker test, nuclear renography, and urodynamic techniques. Presence of infection with obstruction constitutes a urological emergency and urgent decompression is warranted. The pathophysiological effects of unilateral or bilateral upper tract obstruction differ and have important implications for clinical management of patients. The management of numerous upper urinary tract obstructive conditions is discussed.
Obstructive uropathy
Upper urinary tract
Cystourethrography
Urinary tract obstruction
Urinary flow
Urinary obstruction
Pyelogram
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Almost one-quarter of the children referred to a pediatric urologist for obstructive uropathy suffer from an obstructive megaureter. However, not all megaureters are due to obstruction, as some may be the result of reflux and many simply represent a slightly skewed stage of development that can result in a normal urinary tract if observed. As the use of fetal ultrasonography has expanded, the majority of children with megaureters are now diagnosed early in their development, and physicians are faced with the complex task of distinguishing which children need medical intervention and which do not. The surgical treatments of megaureter are well established, relatively simple, and effective if performed in the correct candidates. Therefore, research efforts in this field have recently focused on improving our ability to diagnose clinically relevant obstructive uropathy and examining the developmental causes of megaureter, and how this disorder may be prevented.
Megaureter
Obstructive uropathy
Ureterocele
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Objective To describe the occurrence of obstructive uropathy in the absence of dilatation of the urinary tract. Clinical features Five cases of non-dilated obstructive nephropathy are described. All patients were uraemic on presentation. Obstruction was caused by retroperitoneal malignancy in two patients and uric acid lithiasis in the remaining three. All patients had at least one ultrasound examination. Isotope renography and computed tomography were performed in three and four patients respectively. None of these imaging techniques suggested obstruction in any of the cases. Radionuclide scans were characterised by unusually poor perfusion and parenchymal phase images. Intervention and outcome An immediate diuresis and a rapid return of normal renal function occurred after relief of the obstruction in all cases. Conclusion The absence of dilatation in obstructive nephropathy is uncommon but may be responsible for delayed diagnosis and management of a readily treatable cause of acute renal failure.
Obstructive uropathy
Urinary tract obstruction
Urinary obstruction
Upper urinary tract
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Obstructive uropathy
Urinary tract obstruction
Anuria
Hydrostatic pressure
Urination
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Renal pelvis
Upper urinary tract
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To show the pathologic characteristics of upper urinary tract tumors with special emphasis on the peculiarities due to anatomical site and secondary to endoscopic treatment.Bibliographic review and presentation of our ten-year experience at the "Hospital Ramon y Cajal" Pathology Department in Madrid studying 203 urothelial tumors of the ureter, renal pelvis and calyces.More than 95% of the upper urinary tract tumors in adults have their origin in the urothelium, and most of them are either malignant or potentially malignant. Their biological behaviour is similar to bladder tumors, although they have some peculiarities due to their anatomical localization. Tumors at the renal calyces may be more aggressive due to their particular way of intrarenal dissemination.Anatomical localization and proper pathological study are the determinant factors to establish prognosis and possible adjuvant treatment for upper urinary tract tumors after endoscopic resection.
Renal pelvis
Upper urinary tract
Presentation (obstetrics)
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Several terms usually describe obstruction of the urinary tract and its consequences such as hydronephrosis, obstructive uropathy, and obstructive nephropathy. Obstruction can be due to anatomical or functional abnormalities of the urethra, bladder, ureter, or renal pelvis. These abnormalities can be congenital or acquired. Obstructive uropathy also can occur during the course of diseases extrinsic to the urinary tract. This is a reversible cause of renal impairment and calls for urgent diagnosis and treatment to prevent chronic irreversible renal scarring and consequent progressive chronic renal disease.
Obstructive uropathy
Urinary tract obstruction
Renal pelvis
Urologic disease
Urinary obstruction
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Obstructive uropathy
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Introduction. Currently, there are more than 200 methods of surgical treatment of a megaureter, but none of the methods has achieved universal acceptance. Until now, the issues of differential diagnosis of organic and functional causes of ureteral dilatation in children under 3 years of age have not been sufficiently illuminated, there is no generally accepted algorithm for the management of patients with this pathology.
Relevance. The relevance of obstructive uropathies is evidenced by the fact that they occupy the third position in the list of the most common causes of chronic kidney disease in children, and account for 15% of cases. The prognosis of the outcome of obstructive uropathy is determined by the nature of the lesion and the degree of involvement in the pathological process of the kidneys, one of the main homeostatic and endocrine organs in humans. The degree of involvement of various markers in the development and progression of kidney damage in children is still insufficiently understood. All this prompts the search for screening, highly sensitive and specific methods for the diagnosis and prediction of nephrosclerotic changes in children against the background of urinary tract obstruction.
Objective: The study of the clinical and laboratory diagnostic methods, allowing to differentiate functional or organic urodynamic disorders, to determine the tactics of managing patients with obstructive uropathy.
Materials and methods. Since 2016, a study has been conducted of 174 children aged 0 to 18 years. 3 groups of children were identified: 1) with endoscopic treatment (main group); 2) treated with an open surgical method (control group); and 3) a group of children without urinary tract obstruction (reference group).
Results. In the course of the study, it was found that the most optimal values of serum cystatin C, close to the reference group (0.048-0.831 mg/ml) were obtained in children treated with endoscopic correction of the intramural ureter (0.217-0.798 mg/ml).
Conclusions. The tactics of endoscopic treatment of obstructive uropathies in children has advantages in terms of open surgical methods in technical simplicity, minimally invasiveness, maximum physiology, and a decrease in the frequency of postoperative complications. These theses are confirmed by the obtained results of the study of serum cystatin C as a marker of the state of renal filtration. It should be remembered that the effectiveness of endoscopic stenting of the lower ureter depends on the age of the child.
Obstructive uropathy
Megaureter
Ureterocele
Urologic disease
Posterior urethral valve
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