Banerjee Indraneel, Tomar Vinay, Yadav Sher Singh, Vyas Nachiket, Yadav Suresh, Sathian Brijesh
Senior Resident, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
Professor and Head of Department, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
J Clin Diagn Res. 2016 Sep;10(9):PC08-PC11. doi: 10.7860/JCDR/2016/21400.8453. Epub 2016 Sep 1.
The most common cause of adult Giant Hydronephrosis (GH) is congenital Uretero-Pelvic Junction (UPJ) obstruction. Conventional imaging modalities, like Intravenous Urography (IVU) and Computed Tomography Urography (CTU) and radionuclide renal scan can be fallacious. Serum carbohydrate antigen 19-9 (CA19-9) is a useful tumour marker for gastrointestinal and pancreatic cancer. Only a few studies and case reports have shown raised serum levels due to benign hydronephrosis and GH.
To investigate the prognostic role of urine and serum CA19-9 in the diagnosis and follow-up of adult GH due to UPJ obstruction.
The present hospital based observational study was conducted on 24 adult patients (Group 1) with unilateral GH due to UPJ obstruction. Twenty four healthy adults were included as control (Group 2). Serum and voided urine samples were collected to evaluate Carbohydrate Antigen (CA) 19-9 in each group. During surgery, urine from the affected pelvis was collected to determine CA19-9 level. Patients were followed up after surgery at 3 and 9 months with serum and voided urine samples for CA19-9 level.
Preoperative Serum and voided urine CA19-9 were significantly greater in Group1 than in controls, which significantly correlated inversely with preoperative percentage renal function and glomerular filtration rate. Postoperative improvement in renal function significantly correlated inversely with serum and voided urine CA19-9 at 3 and 9 months.
Voided urine CA19-9 can be a non-invasive clinical marker in adult GH due to UPJ obstruction. The clinical implications of these data for diagnosis and follow-up of these patients are significant. Our findings suggest, significant decrease in urinary Ca19-9 level during follow-up is predictive of excellent surgical outcome and resolution of renal damage.
成人巨大肾积水（GH）最常见的病因是先天性输尿管肾盂连接部（UPJ）梗阻。传统的成像方式，如静脉肾盂造影（IVU）、计算机断层扫描尿路造影（CTU）和放射性核素肾扫描可能会产生错误结果。血清糖类抗原19-9（CA19-9）是用于胃肠道和胰腺癌的一种有用的肿瘤标志物。仅有少数研究和病例报告显示，良性肾积水和GH可导致血清水平升高。
探讨尿液和血清CA19-9在因UPJ梗阻所致成人GH的诊断及随访中的预后作用。
本基于医院的观察性研究对24例因UPJ梗阻导致单侧GH的成年患者（第1组）进行了研究。纳入24名健康成年人作为对照组（第2组）。收集血清和晨尿样本以评估每组中的糖类抗原（CA）19-9。手术过程中，收集患侧肾盂的尿液以测定CA19-9水平。术后3个月和9个月对患者进行随访，采集血清和晨尿样本检测CA19-9水平。
第1组术前血清和晨尿CA19-9显著高于对照组，且与术前肾功能百分比和肾小球滤过率呈显著负相关。术后3个月和9个月，肾功能的改善与血清和晨尿CA19-9呈显著负相关。
晨尿CA19-9可作为因UPJ梗阻所致成人GH的一种非侵入性临床标志物。这些数据对这些患者诊断和随访的临床意义重大。我们的研究结果表明，随访期间尿Ca19-9水平显著降低预示着手术效果良好及肾损伤得到缓解。
