Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management

Klaus, Richard; Lange-Sperandio, Bärbel

doi:10.3390/biomedicines10081894

Cited by 17 publications

(13 citation statements)

References 86 publications

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“…Other possible prognostic factors include echographic parameters, urinary and biochemical markers, prenatal parameters, and proteomic data. Klaus et al concluded that the best postnatal predictor for progression to CKD was nadir serum creatinine after valve ablation, while the values of other urinary markers beyond microalbuminuria were poor, and novel postnatal biomarkers should be further investigated ( 42 , 17 ). The final validation of the 12PUV signature is ongoing in the first clinical proteomics study in prenatal medicine.…”

Section: Discussionmentioning

confidence: 99%

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis

et al. 2023

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BackgroundPosterior urethral valves (PUVs) represent the most severe pediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%–21% of patients. Unfortunately, renal outcomes have poorly improved over time. The key point is to identify patients at risk; thus, several prenatal and postnatal prognostic factors have been analyzed to improve clinical outcomes. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding.ObjectiveWe performed a systematic review with meta-analysis to analyze the predictive value of nadir creatinine on long-term renal function in infants with PUVs.MethodsWe conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps.ResultsA total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analyzed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35–25.17, I2 = 92.20%, p < 0.001).ConclusionsNadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.

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Section: Discussionmentioning

confidence: 99%

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis

et al. 2023

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“…The long-term implications of improved bladder health in LUTO cases may have significant downstream effects on the kidneys, as some of the long-term renal deterioration in these patients can be directly related to an end-stage high pressure poorly compliant bladder. 47 Based on prior studies and the current bench-top performance of our one-way valve fetal shunt, we anticipate a significant urologic benefit that will favor the placement of shunts in a wider range of LUTO patients, including LUTO cases with normal amniotic fluid volume, which have also shown an increased risk of worsening renal functional and need of renal replacement therapy later in life. Cases of LUTO with normal amniotic fluid volume are not generally considered candidates for VAS.…”

Section: Discussionmentioning

confidence: 99%

Development and validation of a novel fetal vesico‐amniotic shunt, the vortex shunt

Blumenfeld,

Sheth,

Johnson

et al. 2023

Prenatal Diagnosis

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Fetal lower urinary tract obstruction (LUTO) is a severe malformation associated with an up to 80% mortality risk as well as significant renal and pulmonary morbidity in survivors. Fetal vesico‐amniotic shunts (VAS) bypass the bladder obstruction, improve amniotic fluid volume and enhance in‐utero pulmonary development. VAS has been shown to reduce respiratory morbidity and mortality in the neonatal period without proven benefit on long‐term renal and bladder function. Clinically available shunts are associated with an up to 80% dislodgement rate, leading to repeat invasive procedures which increase fetal and maternal risks. We developed a novel “Vortex” shunt, which incorporates enhanced fixation to reduce dislodgement, a one‐way valve to optimize in‐utero bladder function, and enhanced sonographic echogenicity that optimizes the accurate deployment. Following the validation of these characteristics in initial benchtop experiments we have moved to feasibility studies in the fetal lamb model. We hope that the Vortex shunt may ultimately facilitate shunt deployment, reduce dislodgement risk, improve neonatal morbidity and mortality, and decrease the significant healthcare expenditures associated with long‐term morbidity in LUTO survivors. In this manuscript, we review the natural history of LUTO, the risks and benefits of clinically available fetal shunts, and our development and early validation experiments.

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“…Whilst the prevalence of UTIs was common in women in this study, the risk of MDR infection was significantly higher in males compared to women. UTIs in males are usually associated with a urological abnormality, such as prostatic hyperplasia or posterior urethral valves that are usually associated with instrumentation and risk of infection [ 36 , 37 , 38 ]. Lastly, the highest risk of MDR was found in patients with the presence of antibiotics in the urine.…”

Section: Discussionmentioning

confidence: 99%

High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017–2021

Asamoah¹,

Gupte

Davtyan³

et al. 2022

IJERPH

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Management of urinary tract infections is challenged by increasing antimicrobial resistance (AMR) worldwide. In this study, we describe the trends in antimicrobial resistance of uropathogens isolated from the largest private sector laboratory in Ghana over a five-year period. We reviewed positive urine cultures at the MDS Lancet Laboratories from 2017 to 2021. The proportions of uropathogens with antimicrobial resistance to oral and parenteral antimicrobials recommended by the Ghana standard treatment guidelines were determined. The proportion of multi-drug resistant isolates, ESBL and carbapenemase-producing phenotypes were determined. Of 94,134 urine specimens submitted for culture, 20,010 (22.1%) were culture positive. Enterobacterales was the most common group of organisms, E. coli (70.6%) being the most common isolate and Enterococcus spp. the most common gram-positive (1.3%) organisms. Among oral antimicrobials, the highest resistance was observed to ciprofloxacin (62.3%) and cefuroxime (60.2%) and the least resistance to fosfomycin (1.9%). The least resistance among parenteral antimicrobials was to meropenem (0.3%). The highest multi-drug resistance levels were observed among Klebsiella spp. (68.6%) and E. coli (64.0%). Extended-spectrum beta-lactamase (ESBL) positivity was highest in Klebsiella spp. (58.6%) and E. coli (50.0%). There may be a need to review the Ghana standard treatment guidelines to reflect increased resistance among uropathogens to recommended antimicrobials.

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Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management

Cited by 17 publications

References 86 publications

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis

Development and validation of a novel fetal vesico‐amniotic shunt, the vortex shunt

High Resistance to Antibiotics Recommended in Standard Treatment Guidelines in Ghana: A Cross-Sectional Study of Antimicrobial Resistance Patterns in Patients with Urinary Tract Infections between 2017–2021

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