This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. In order to further evaluate the possible utility of TGF-b1 as a urinary marker of significant upper tract obstruction a key piece of information is needed. The urinary concentration of TGF-b1 of children with upper tract dilation requiring surgery versus children with upper tract dilation not requiring surgery are studied prospectively in this protocol. If a difference is found between these 2 study groups, TGF-b1 could be utilized as a non-invasive test to screen and follow children with upper tract dilation and help discern which children will require intervention in a future trial.. The goal of this study is to discover a reliable urinary marker for diagnosis and follow-up of these patients. The goal is avoiding to perform a complex and invasive radiologic tests now performed to make clinical judgments. The study will recruit children with prenatal and/or neonatal diagnosis of isolated unilateral grade 3-4 hydronephrosis with no other significant urinary abnormalities presenting to our urology clinic within their first month of age or referred from the prenatal clinic. Urine will also be collected at the time of surgery for patient, requiring surgery, from the obstructed kidney as well as the bladder. The control group will consist of children presenting to the child health clinic for routine check up All patients in this study undergo detailed clinical and radiological evaluation as part of established protocols of management, not only to confirm the diagnosis of unilateral hydronephrosis but also to filter out other pathologies, which may effect the research outcome. Our exclusion criteria are aimed at minimizing possible confounding factors by eliminating all subjects with any systemic or localized disease other than unilateral hydronephrosis. The control group will be recruited via the child health clinic at 'The Children's Hospital' who present for routine check up. For the purpose of age matching we will recruit 12 subjects from each age group as follows: Ages 0 - 3 months, 4 - 7 months, 8 - 11 months, 12 - 17 months and 18 - 24 months. The control urines will be obtained via bag or voided specimen collection.
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