Can baseline serum creatinine and e-GFR predict renal function outcome after augmentation cystoplasty in children?

Abstract

ObjectiveTo assess cut-off value of creatinine and glomerular filtration rate for augmentation cystoplasty (AC) in paediatric age-group.Materials and MethodsData of all paediatric-patients (<18 years) with small capacity bladder, in whom AC was advised between 2005-2015 were reviewed. All patients were divided in two-groups, AC-group and control-group (without AC). Creatinine and e-GFR were assessed at the time of surgery, at 6 months and at last follow-up. Renal function deterioration was defined as increase in creatinine by ≥25% from baseline value or new-onset stage-3 CKD or worsening of CKD stage with pre-operative-CKD stage-3. ROCs were plotted using creatinine and e-GFR for AC.ResultsA total of 94 patients with mean-age 8.9 years were included. The mean creatinine and e-GFR were 1.33mg/dL and 57.68mL/min respectively. Out of 94 patients, AC was performed in 45 patients and in the remaining 49 patients AC was not done (control-group), as they were not willing for the same. Baseline patient's characteristics were comparable in both Groups. 22 underwent gastro-cystoplasty (GC) and 25 underwent ileo-cystoplasty (IC). Decline in renal function was observed in 15 (33.3%) patients of AC-group and in 31 (63.3%) patients of control-group. Patients having creatinine ≥1.54mg/dL (P=0.004, sensitivity (S) 63.6% and specificity (s) 90.5%) at baseline and e-GFR ≤46mL/min (P=0.000, S=100% and s=85.7%) at the time of surgery had significantly increased probability of renal function deterioration on follow-up after AC.Conclusione-GFR ≤46mL/min and creatinine ≥1.54mg/dL at time of surgery could serve as a predictor of renal function deterioration in AC in paediatric patients.

Ten years’ experience of augmentation cystoplasty for varied indications and its outcome

“…19 Singh et al in their study concluded that glomerular filtration rate ≤4 ml/min and serum creatinine 1.54 mg/dl at time of surgery could serve as predictors of renal function deterioration in augmentation cystoplasty in paediatric patients. 20 Similarly Bhattia et al suggested that BA, when otherwise indicated, has been beneficial in children with pre-augmentation creatinine up to 2 mg/dl. 21 Thus BA does not reverse renal failure although it can delay the onset of end-stage disease.…”

A single centre 10-year experience of Mitrofanoffs procedure for varied indications with its outcome

“…10 Singh P et al, in their study concluded that Glomerular filtration rate ≤4mL/min and serum creatinine 1.54mg/dL at time of surgery could serve as predictors of renal function deterioration in augmentation cystoplasty in pediatric patients. 11 Similarly, William Bhatti a, Sudipta Sen et al, suggested that , bladder augmentation when otherwise indicated, has been beneficial in children with preaugmentation creatinine up to 2 mg/dl. 12 Thus, bladder augmentation with mitrofanoffs procedure does not reverse renal failure although it can delay the onset of end-stage disease.…”