Risk factors for progression to end-stage renal disease in children with posterior urethral valves |
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| Authors: | MS Ansari Anil Gulia Aneesh Srivastava Rakesh Kapoor |
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| Institution: | 1. Department of Urology, University of Campinas, Campinas, São Paulo, Brazil;2. Department of Nephrology, University of Campinas, Campinas, São Paulo, Brazil;1. Al Adan Hospital, Pediatric Department, Neurology Unit, Kuwait;2. Clinical Center Nis, Institute of Radiology, Serbia;3. Al Adan Hospital, Pediatric Department, Kuwait;1. Service de médecine physique et de réadaptation fonctionnelle, CHU Ibn Rochd, Casablanca, Maroc;2. Service d’urologie, CHU Ibn Rochd, Casablanca, Maroc;3. Service de chirurgie pédiatrique, hôpital d’enfants, Casablanca, Maroc;1. Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon;2. Department of Medicine and Therapeutics, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana;3. Paediatric Nephrology and Hypertension Unit, Department of Paediatrics, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria;4. Renal Unit, Department of Medicine, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, State of Osun, Nigeria;5. Internal Medicine-Nephrology, Cheikh Anta Diop University, Dakar, Senegal;6. Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK;7. Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;8. Institute of Biomedical Ethics, University of Zurich, Zurich, Switzerland;1. Division of Pediatric Surgery/Urology, Federal Fluminense University, Antônio Pedro University Hospital, Rio de Janeiro, Brazil;2. Division of Pediatric Urology, Department of Surgery, Sidra Medical and Research Center, Doha, Qatar |
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| Abstract: | ObjectiveTo identify the variables which affect long-term renal outcome in children with posterior urethral valves (PUV).Materials and methodsRetrospective analysis of 260 children with PUV who underwent ablation of valves in 1992–2008 at our tertiary care center. The following risk factors for progression to end-stage renal disease (ESRD) were analyzed: nadir serum creatinine greater than 1.0 mg/dl, bilateral grade 3 or higher VUR at diagnosis, recurrent febrile UTIs, and severe bladder dysfunction. Patients were divided into two groups: those who developed ESRD (group 1) and those who did not (group 2).ResultsForty (17.62%) patients had nadir serum creatinine >1 mg/dl. At time of initial presentation, high-grade VUR was seen in 63.1% and 33.5% of groups 1 and 2, respectively (P = 0.002). Overall, 77 (34%) of the boys developed breakthrough urinary tract infections: 37.03% and 33.5% in groups 1 and 2, respectively (P = 1). Fifty-nine (26%) patients were found to have severe bladder dysfunction: 77.8% and 19% in groups 1 and 2, respectively (P < 0.0001). Twenty-seven (11.89%) patients progressed to ESRD, at mean age of 11.21 years (5–16). On univariate analysis, the risk-predicting variables were: nadir serum creatinine value greater than 1 mg/dl (P < 0.0001), bilateral high-grade VUR (P = 0.002) and severe bladder dysfunction (P < 0.0001). On multivariate logistic regression analysis, nadir serum creatinine greater than 1 mg/dl (OR 23.79; CI 8.20–69.05) and severe bladder dysfunction (OR 5.67; CI 1.90–16.93) were found to be independent risk factors predictive of ultimate progression to ESRD.ConclusionsNadir serum creatinine and bladder dysfunction are the main factors affecting long-term renal outcome in cases of PUV. Early identification and treatment of bladder dysfunction may thus be beneficial. |
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