The Role of Biomarkers in Determining Surgical Indications and Follow-up of Congenital Ureteropelvic Junction Obstruction

Objective: In this study, we aimed to evaluate the potential roles of various biomarkers (serum total thiol, urinary neutrophil gelatinase-associated lipocalin (NGAL) tumor necrosis factor- α (TNF-α), transforming growth factor β (TGF-β) and Vanin-1) in disease staging, determining surgical indications, and postoperative follow-up in pediatric patients diagnosed with congenital ureteropelvic junction obstruction (UPJO).Methods: A prospective study included 64 pediatric patients diagnosed with UPJO between 2019 and 2022. Patients were grouped according to the Society of Fetal Urology (SFU) staging system and treatment plan. Biomarker levels were measured using the ELISA method from serum and urine samples. Preoperative and 6-month postoperative biomarker levels were compared in patients who underwent surgery.Results: Serum total thiol levels were found to be significantly higher in the SFU Grade 4 and surgical groups (p=0.023 and p=0.0339). Urinary NGAL levels also showed a significant increase in the surgical group and patients with advanced stage disease (p=0.0017 and p=0.007). TNF-α and TGF-β levels did not show significant differences between groups. Vanin-1 levels significantly increased after surgery (p=0.008), and the AUC value in ROC analysis was found to be 0.864 (cut-off: 1.15; 100% specificity, 66.7% sensitivity).Conclusions: Serum total thiol and urinary NGAL levels stand out as biomarkers associated with disease severity and surgical necessity, while Vanin-1 may be a potential follow-up tool for assessing the postoperative recovery process. It is considered that these biomarkers should be evaluated as non-invasive tools that can support clinical decisions in diagnosis, treatment, and follow-up processes.