Evaluation of Caspase 3 Enzyme and TNF-alpha as Biomarkers in Ureteropelvic Junction Obstruction in Children- a preliminary report

OBJECTIVE: To determine the applicability of urinary caspase 3 enzyme and TNF-α as biomarkers in children with ureteropelvic junction obstruction (UPJO). METHODS: In this study, 31 unilateral UPJO patients and 33 age- and sex-matched healthy childrens were enrolled. The patients with UPJO consisted of 11 female and 20 male children between the ages of 2 to 62 months old. All participants were evaluated regarding anterior-posterior(AP) diameter and cortical thickness of affected kidney by ultrasonography. Technetium DTPA renal scan and voiding cystourethrogram(to assess vesicoureteral reflux) were performed, pre-operatively. Also, urinary levels of TNF-α and caspase 3 enzyme were checked. Follow-ups included measurement of aforementioned indices in patients: AP diameter and cortical thickness of the affected kidney, as well as TNF-α and caspase 3 levels in urine, three and six months after pyeloplasty. RESULTS: The results showed highly significant decrease in urinary TNF-α and caspase 3 enzyme (P values < 0.01), approaching the level measured in children without UPJO after six months. Significant decrease in AP diameter and increase in cortical thickness were also noticed (P values < 0.01). CONCLUSION: The results of this study strongly support that TNF-α and caspase 3 levels in urine can be used for improvement monitoring in follow-up of UPJO patients after pyeloplasty and can also be potentially used as determining indices for surgical plan but more studies, especially in patients who are not surgical candidates are needed to confirm our observaitons.