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Abstract: FR-PO1083

HIP/PAP and BD-1 Indicate Successful Surgical Intervention in Pediatric Patients with Ureteropelvic Junction Obstruction

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Gupta, Sudipti, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Nicassio, Lauren, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Yepes, Guillermo J., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Jackson, Ashley R., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Mcleod, Daryl J., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Becknell, Brian, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Ching, Christina B., Nationwide Children's Hospital, Columbus, Ohio, United States
Background

We have previously found a panel of antimicrobial peptides (AMPs) to be significantly elevated in ureteropelvic junction obstruction (UPJO). We sought to see if these same AMPs decreased after surgical correction of UPJO to further test their ability to identify obstruction.

Methods

Bladder urine was collected from pediatric patients (≤18 years old) immediately prior to surgical correction of an UPJO and then at least 6 months after surgery according to an IRB-approved protocol. Patients were included only if they did not have signs of active urinary tract infection at time of collection. Based on a prior study demonstrating that the AMPs beta defensin 1 (BD-1), hepatocarcinoma-intestine-pancreas/pancreatitis-associated protein (HIP/PAP), LL-37, and neutrophil gelatinase-associated lipocalin (NGAL) were significantly elevated in patients with UPJO as compared to patients without, we performed enzyme-linked immunosorbent assays on these four AMPs to compare their expression before and after surgical intervention. AMP levels were normalized to urine creatinine. Results were analyzed with paired t test or Wilcoxon test using Graphpad software. A p-value of <0.05 was considered significant.

Results

Follow-up samples were obtained a median of 27.4 months (average 27.4; range 7.8-45.3 months) after surgery and removal of all drainage tubes on 13 patients on whom we also had urine samples collected immediately prior to pyeloplasty for their UPJO. Nine of the patients were male. Their age at urine collection at time of surgery was a median of 4.3 years (average 6.1; range 0.4-18.4 years). All 13 patients showed clinical improvement from before surgery and/or signs of improved hydronephrosis on post-operative imaging. We found that HIP/PAP and BD-1 were significantly decreased in post-surgical samples compared to pre-surgical samples (p=0.0215 and 0.0052, respectively); NGAL and LL-37 did not significantly change. The sensitivity/specificity of HIP/PAP to show correction of an obstruction was 77% and 85%, respectively, while for BD-1 it was 75% and 67%, respectively.

Conclusion

HIP/PAP and BD-1 are significantly elevated in upper urinary tract obstruction and significantly decrease with correction. These AMPs could serve as markers of successful surgical intervention.