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

PURPOSEto correlate severity of UPJO with immunohistochemical findings andradionuclide renal scan split function (SF), to obtain indications and timingof surgical correction of congenital UPJO.MATERIAL AND METHODS21 patients, 57-105 days old, were studied. UPJO was assessed by MAG 3diuretic renography. Patients underwent biopsy at pyeloplasty. Histologicaland himmunoistochemical analysis for Bcl-KL, Bcl2, AKT-1, BAD, Bax, AIF,FAS FAS-L, H-TERT, Mib-1 and Nocth2 was performed. TUNEL techniquewas used to detect apoptotic nuclei. Severity of UPJO was assessed intraoperativelyand histologically. Renography was repeated one year aftersurgery.RESULTSAll patients showed half-time washout > 20 minutes, pre-operative SFranged from 19 to 54% (average 39.69±12.37%). Pyeloplasty was performedat mean age of 73 days. Twelve patients showed a tightened stenosis ,9 a severe stenosis. Pre-operative SF was >40% on 66% of patients withtightened UPJO, whereas only in 33,3% with severe UPJO. Tubular damageoccurred on 87.5% of patients, whereas glomerular changes were detecton 3 patients with severe UPJO only. Apoptotic activity was significantlyexpressed on severe stenosis population than tightened UPJO. Proliferationcellular markers were highly expressed in tightened UPJO, with SF >40%.TUNEL reaction was expressed only in severe UPJO. Post-operative SFwas significantly decreased on 66.6% of tightened UPJO patients. PostoperativeSF showed a light increase on severe UPJO patients.CONCLUSIONSCellular proliferation was significantly increased in tightened UPJO,whereas apoptosis increased in severe UPJO. Based on our results earlysurgical correction is recommended even if the SF is > 40% to limit furtherloss of renal function.