he elusive search for being able to diagnose pelvi-ureteric junction obstruction (PUJO) continues and this group of researchers investigated the possible clinical application of urinary neutrophil gelatinase-associated lipocalin (uNGAL), urinary kidney injury molecule-1 (uKIM-1) and urinary liver-type fatty acid-binding proteins (uL-FABP) as biomarkers for identifying the need for surgery. Two groups of children (group one – 23 boys, 3 girls; median age 21 months, range 1-48 with severe hydronephrosis, grade 3-4, and dysfunction; group 2 – 30 boys, 6 girls; median age 19.5 months, range 3-48 with mild hydronephrosis, grade 1-2 and no dysfunction) had urine collected for these markers and their ratios with creatinine (Cr) were calculated. Twenty healthy children (15 boys, 5 girls; median age 36 months, range 1-48) are used as controls. The Society of Fetal Urology (SFU) grading of hydronephrosis was used and dysfunction was identified with a technetium MAG3. Receiver-operating characteristic (ROC) curves were plotted to illustrate and evaluate the optimal cut-off concentrations for uKIM-1, uNGAL and L-FABP, which yielded the highest sensitivity and highest specificity. Hydronephrosis was commoner in males than females by a ratio of 9:1. The median uKIM-1/Cr and uL-FABPs/Cr rates were not significantly different between patient groups and controls (p > 0.05) but uNGAL/Cr concentrations were significantly higher in group 1 than in group 2 patients and controls (p<0.05) and the median uNGAL/Cr values of group 2 did not differ significantly from healthy controls (p>0.05). ROC analyses revealed that uNGAL/Cr could provide fairly good diagnostic accuracy for dysfunction (sensitivity 58%, specificity 75%) but none of the others could. The authors conclude that uNGAL/Cr has potential for identifying dysfunction, allowing decision-making for surgery to occur when other parameters are unclear.