Long-Term Risk of End Stage Renal Disease in Patients With Posterior Urethral Valves

Heikkilä, Jukka; Holmberg, Christer; Kyllönen, L.; Rintala, Risto; Taskinen, Seppo

doi:10.1016/j.juro.2011.07.109

Cited by 120 publications

(80 citation statements)

References 25 publications

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“…Unfortunately, negative predictive value remains low. Thus, in a proportion of cases, urethral valve obstruction is part of more complex nephrourologic disorder in which primary renal dysplasia and end-stage failure may appear in utero or later in life irrespective of bladder decompression [31,32]. …”

Section: Discussionmentioning

confidence: 99%

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

et al. 2015

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Objective: To report the results of fetal cystoscopic laser ablation of posterior urethral valves (PUV) in a consecutive series in two referral centers. Methods: Twenty pregnant women with a presumptive isolated PUV were treated with fetal cystoscopy under local anesthesia. Identification and fulguration of the PUV by one or several firing-contacts with diode laser were attempted. Perinatal and long-term outcomes were prospectively recorded. Results: The median gestational age at procedure was 18.1 weeks (range 15.0-25.6), and median operation time was 24 min (range 15-40). Access to the urethra was achieved in 19/20 (95%) cases, and postoperative, normalization of bladder size and amniotic fluid was observed in 16/20 (80%). Overall, there were 9 (45%) terminations of pregnancy and 11 women (55%) delivered a liveborn baby at a mean gestational age of 37.3 (29.1-40.2) weeks. No infants developed pulmonary hypoplasia and all were alive at 15-110 months. Eight (40% of all fetuses, 72.7% of newborns) had normal renal function and 3 (27.3%) had renal failure awaiting renal transplantation. Conclusion: Fetoscopic laser ablation for PUV can achieve bladder decompression and amniotic fluid normalization with a single procedure in selected cases with anyhydramnios. There is still a significant risk of progression to renal failure pre or postnatally.

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Section: Discussionmentioning

confidence: 99%

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

et al. 2015

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“…After birth, CKD progresses in a significant proportion of these boys [10,11,12,13,14,15,16], yet the reasons for this progression are not well understood. This report defines a number of antenatal determinants of poor postnatal kidney outcome and ESRD, including oligohydramnios and antenatal ultrasound signs of parenchymal injury of the fetal kidney.…”

Section: Discussionmentioning

confidence: 99%

Antenatal Determinants of Long-Term Kidney Outcome in Boys with Posterior Urethral Valves

Matsell

Morrison³

2015

Fetal Diagn Ther

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Background: Posterior urethral valves (PUV) are the most important cause of end-stage renal disease (ESRD) in young boys. The objective of this report was to define the antenatal determinants of long-term postnatal renal outcome in this condition. Design: This was a retrospective cohort analysis. The primary outcome was the development of ESRD defined as starting dialysis or receiving a preemptive kidney transplant. Results: Eighty-two cases of PUV were identified, with 17 (21%) developing ESRD at 6.1 ± 7.1 years. Cases developing ESRD were more likely diagnosed antenatally (41 vs. 19%, p = 0.05), had a younger gestational age (35.5 ± 3.4 weeks vs. 37.3 ± 2.1 weeks, p = 0.02), and on antenatal ultrasound scan were more likely to have oligohydramnios (60 vs. 26%, p = 0.02), renal cortical cysts (47 vs. 17%, p = 0.02), and the combination of oligohydramnios, renal cortical cysts, and increased renal echogenicity (47 vs. 9%, p = 0.002). Conclusions: In boys with PUV, decreased gestational age, oligohydramnios, renal cysts, and the combination of oligohydramnios, cortical cysts, and echogenic kidneys were associated with ESRD, while the combination was an independent predictor of poor long-term postnatal kidney function.

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“…that requires decompression with patients commonly left with significant residual kidney impairment that has no current treatment options and may eventually lead to end stage kidney disease. 8,9 The models detailed here enable the study of both irreversible UUO and R-UUO. Irreversible UUO allows the study of inflammation and tissue injury including the role of various leukocytes and mediators [1][2][3]10 whilst study of the R-UUO model enables researchers to explore the resolution of renal injury and associated tissue remodeling.…”

Section: Discussionmentioning

confidence: 99%

A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction

Hesketh

Vernon

Ding

et al. 2014

JoVE

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Obstruction of the kidney may affect native or transplanted kidneys and results in kidney injury and scarring. Presented here is a model of obstructive nephropathy induced by unilateral ureteric obstruction (UUO), which can either be irreversible (UUO) or reversible (R-UUO). In the irreversible UUO model, the ureter may be obstructed for variable periods of time in order to induce increasingly severe renal inflammation and interstitial fibrotic scarring. In the reversible R-UUO model the ureter is obstructed to induce hydronephrosis, tubular dilation and inflammation. After a suitable period of time the ureteric obstruction is then surgically reversed by anastomosis of the severed previously obstructed ureter to the bladder in order to allow complete decompression of the kidney and restoration of urinary flow to the bladder. The irreversible UUO model has been used to investigate various aspects of renal inflammation and scarring including the pathogenesis of disease and the testing of potential anti-inflammatory or anti-fibrotic therapies. The more challenging model of R-UUO has been used by some investigators and does offer significant research potential as it allows the study of inflammatory and immune processes and tissue remodeling in an injured and scarred kidney following the removal of the injurious stimulus. As a result, the R-UUO model offers investigators the opportunity to explore the resolution of kidney inflammation together with key aspects of tissue repair. These experimental models are of relevance to human disease as patients often present with obstruction of the renal tract that requires decompression and are commonly left with significant residual kidney impairment that has no current treatment options and may lead to eventual end stage kidney failure. Video LinkThe video component of this article can be found at

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Long-Term Risk of End Stage Renal Disease in Patients With Posterior Urethral Valves

Abstract: Congenital obstructive uropathy can lead to end stage renal disease during childhood or young adulthood. However, the risk of end stage renal disease seems to decrease eventually. Poor kidney function at presentation is associated with worse renal prognosis.

Cited by 120 publications

References 25 publications

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

Laser Ablation of Posterior Urethral Valves by Fetal Cystoscopy

Antenatal Determinants of Long-Term Kidney Outcome in Boys with Posterior Urethral Valves

A Murine Model of Irreversible and Reversible Unilateral Ureteric Obstruction

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