CONGENITAL UNILATERAL URETEROPELVIC JUNCTION OBSTRUCTION:RENAL DAMAGE EVALUATION AND CORRELATION BETWEEN RENAL BIOPSY AND PRE-POSTOPERATIVE RADIONUCLIDE SCAN

Abstract

PURPOSE to correlate severity of UPJO with immunohistochemical findings and radionuclide renal scan split function (SF), to obtain indications and timing of surgical correction of congenital UPJO. MATERIAL AND METHODS 21 patients, 57-105 days old, were studied. UPJO was assessed by MAG 3 diuretic renography. Patients underwent biopsy at pyeloplasty. Histological and himmunoistochemical analysis for Bcl-KL, Bcl2, AKT-1, BAD, Bax, AIF, FAS FAS-L, H-TERT, Mib-1 and Nocth2 was performed. TUNEL technique was used to detect apoptotic nuclei. Severity of UPJO was assessed intraoperatively and histologically. Renography was repeated one year after surgery. RESULTS All patients showed half-time washout > 20 minutes, pre-operative SF ranged from 19 to 54% (average 39.69±12.37%). Pyeloplasty was performed at mean age of 73 days. Twelve patients showed a tightened stenosis , 9 a severe stenosis. Pre-operative SF was >40% on 66% of patients with tightened UPJO, whereas only in 33,3% with severe UPJO. Tubular damage occurred on 87.5% of patients, whereas glomerular changes were detect on 3 patients with severe UPJO only. Apoptotic activity was significantly expressed on severe stenosis population than tightened UPJO. Proliferation cellular markers were highly expressed in tightened UPJO, with SF >40%. TUNEL reaction was expressed only in severe UPJO. Post-operative SF was significantly decreased on 66.6% of tightened UPJO patients. Postoperative SF showed a light increase on severe UPJO patients. CONCLUSIONS Cellular proliferation was significantly increased in tightened UPJO, whereas apoptosis increased in severe UPJO. Based on our results early surgical correction is recommended even if the SF is > 40% to limit further loss of renal function.