Sigumonrong Yacobda Hamonangan, Dharmajaya Ridha, Warli Syah Mirsya, Eyanoer Putri Chairani, Wahyudi Irfan, Sembiring Rosita Juwita, Alferraly Tengku Ibnu, Rusda Muhammad
Neurosurgery.
Community and Preventif Medicine.
Ann Med Surg (Lond). 2023 May 3;85(6):2647-2654. doi: 10.1097/MS9.0000000000000770. eCollection 2023 Jun.
Pelvic-ureteric junction obstruction (PUJO) is considered the most common pathology for hydronephrosis in neonates. Full recovery of kidney impairment due to PUJO is possible, especially when pyeloplasty is indicated as surgery is mostly conducted when deterioration is identified, early detection should be considered to prevent further complications. Commonly used kidney damage biomarkers are not sensitive enough to predict kidney damage. Neutrophil gelatinase-associated lipocalin (NGAL) and urinary interleukin 18 (IL-18) are markers of early kidney damage with different characteristics. This study aimed to evaluate the relationship between these two markers with the degree of histopathological kidney damage in Wistar rats induced by PUJO.
A total of thirty male Wistar rats, 200-250 g, were divided into three groups: (1) control, (2) sham, (3) PUJO (4th, 7th, 14th, and 21st days). Urine NGAL, IL-18 levels, and renal histopathology were observed on day 0, 4, 7, 14, and 21. Statistical analysis was performed using the Kruskal-Wallis and Mann-Whitney test with less than 0.05 considered significant.
There was no significant difference in urine NGAL levels between groups, while IL-18 levels were significantly different based on the Kruskal-Wallis test ( 0.031). The results of the Mann-Whitney test showed a significant difference in IL-18 levels between the control group and the PUJO group on day 4 (=0.028); the Sham surgery group with the PUJO group on day 4 (=0.014); the PUJO group on day 4 with the PUJO group on the 7th day (=0.008); and the PUJO group on the 7th day with the PUJO group on the 14th day (=0.033).
Urinary IL-18 levels can be used as a predictor of kidney damage in acute-subacute PUJO cases.
肾盂输尿管连接部梗阻（PUJO）被认为是新生儿肾积水最常见的病因。因PUJO导致的肾损伤有可能完全恢复，尤其是在肾盂成形术作为手术指征时，因为手术大多在发现病情恶化时进行，所以应考虑早期检测以预防进一步的并发症。常用的肾损伤生物标志物对预测肾损伤不够敏感。中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和尿白细胞介素18（IL-18）是具有不同特征的早期肾损伤标志物。本研究旨在评估这两种标志物与PUJO诱导的Wistar大鼠肾组织病理学损伤程度之间的关系。
将30只体重200 - 250克的雄性Wistar大鼠分为三组：（1）对照组，（2）假手术组，（3）PUJO组（第4、7、14和21天）。在第0、4、7、14和21天观察尿NGAL、IL-18水平及肾脏组织病理学。采用Kruskal-Wallis检验和Mann-Whitney检验进行统计分析，P值小于0.05被认为具有统计学意义。
各组间尿NGAL水平无显著差异，而基于Kruskal-Wallis检验，IL-18水平有显著差异（P = 0.031）。Mann-Whitney检验结果显示，第4天对照组与PUJO组之间IL-18水平有显著差异（P = 0.028）；第4天假手术组与PUJO组之间（P = 0.014）；第4天PUJO组与第7天PUJO组之间（P = 0.008）；第7天PUJO组与第14天PUJO组之间（P = 0.033）。
尿IL-18水平可作为急性 - 亚急性PUJO病例肾损伤的预测指标。
