Abnormal innervation and altered nerve growth factor messenger ribonucleic acid expression in ureteropelvic junction obstruction.

The pathophysiology of ureteropelvic junction obstruction is unknown. Using specific antibodies, we studied specimens from 35 cases of ureteropelvic junction obstruction and 32 of normal ureteropelvic junction by immunohistochemistry using protein gene product 9.5 (a general neuronal marker), S100 (a supporting cell marker), synaptophysin (a neuromuscular junction marker) and nerve growth factor receptor. Nerve growth factor expression was examined at the messenger ribonucleic acid (mRNA) level using reverse transcription-polymerase chain reaction technique in 11 ureteropelvic junction obstruction specimens and 7 controls. The most striking finding was the marked reduction of protein gene product 9.5, synaptophysin and nerve growth factor receptor staining positive nerve fibers in the muscle layers of ureteropelvic junction obstruction compared to the normal ureteropelvic junction. Supporting nerve cell fibers (S100) were preserved in cases of ureteropelvic junction obstruction and normal ureteropelvic junction. A significantly less intense signal for nerve growth factor mRNA was found in the ureteropelvic junction obstruction specimens compared to normal ureteropelvic junction. These findings suggest that defective innervation may have an important role in the pathogenesis of ureteropelvic junction obstruction, and decreased nerve growth factor mRNA expression may be important in the etiology of ureteropelvic junction obstruction.