title: Role of Urinary and Serum Carbohydrate Antigen 19-9 as a Biomarker in Diagnosis of Adult Giant Hydronephrosis.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  To investigate the prognostic role of urine and serum CA19-9 in the diagnosis and follow-up of adult GH due to UPJ obstruction.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors: Senior Resident, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
authors: Indraneel
authors: I
authors: Banerjee
authors: Professor and Head of Department, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
authors: Vinay
authors: V
authors: Tomar
authors: Professor, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
authors: Sher Singh
authors: SS
authors: Yadav
authors: Associate Professor, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
authors: Nachiket
authors: N
authors: Vyas
authors: Senior Resident, Department of Urology and Renal Transplantation, Sawai Man Singh Medical College and Hospital , Jaipur, Rajasthan, India .
authors: Suresh
authors: S
authors: Yadav
authors: Assistant Professor, Department of Community Medicine, Manipal College of Medical Sciences , Pokhara, Nepal .
authors: Brijesh
authors: B
authors: Sathian
keywords: Biomarker of renal function; Serum CA19-9; Ureteropelvic junction obstruction; Urinary CA19-9