Nadir creatinine predicts long-term bladder function in boys with posterior urethral valves

Delefotrie, T.; Ferdynus, Cyril; Paye-Jaouen, Annabel; Peycelon, Matthieu; Michel, Jean‐Luc; Dobremez, E.; El-Ghoneimi, Alaa; Harper, Luke

doi:10.1016/j.jpurol.2022.01.017

Cited by 7 publications

(2 citation statements)

References 12 publications

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“…Although three heterogeneously defined studies showed that bladder dysfunction is associated with ESKD, with relative risks between 1.15 and 8.9 [ 49 , 57 , 58 ]. Interestingly, the presence of bladder dysfunction has recently been shown to be predicted by nadir creatinine as well [ 59 ], emphasizing that a more severe manifestation affects both bladder and renal function. Urinary tract infections (UTI) can result from bladder dysfunction or vesicoureteral reflux, and can scar kidney tissue through inflammatory processes.…”

Section: Prognostic Factors For Chronic Kidney Disease Developmentmentioning

confidence: 99%

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

Klaus

Lange-Sperandio

2022

Biomedicines

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Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dl implies a very low risk for ESKD, whereas a value above 0.85 mg/dl indicates beneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival.

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Section: Prognostic Factors For Chronic Kidney Disease Developmentmentioning

confidence: 99%

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

Klaus

Lange-Sperandio

2022

Biomedicines

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“…Posterior urethral valves (PUV) represent the most common cause of Lower Urinary Tract Obstruction (LUTO) in boys. They affect 1:4,000-1:25,000 births, and cause increased intravesical pressure during fetal kidney development resulting in various degrees of kidney and bladder impairment (1)(2)(3). We know that bladder profile in boys with PUV can be very varied both in the newborn period, but also with time, with a spectrum going from high pressure, unstable, hypocompliant small bladders to hypercompliant, large acontractile bladders, with some being near-normal.…”

Section: Introductionmentioning

confidence: 99%

Appearance of the bladder on initial voiding cystogram in boys with PUV and its relation to pre and postnatal findings

Pecorelli,

Ferdynus,

Delmas

et al. 2024

Front. Pediatr.

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IntroductionBladder profile in boys with Posterior Urethral Valves can be very varied with a spectrum going from high pressure, unstable, hypocompliant small bladders to hypercompliant, large acontractile bladders, with some being near-normal. Our question was whether appearance, specifically of the bladder, on initial VCUG was correlated to prenatal features and whether it could predict early postnatal outcome.MethodWe used a prospectively gathered database of boys with prenatally suspected PUV. We analyzed whether the appearance, specifically of the bladder, was related to date of prenatal diagnosis, presence of a megacystis on prenatal ultrasound, presence of vesico-ureteral reflux (VUR), presence of abnormal DMSA scan, nadir creatinine or presence of febrile urinary tract infection (fUTI) during the first two years of life.ResultsThe database comprised 90 cystograms. 15% of bladders were judged normal/regular, 54 % were small/diverticular and 31% were large/diverticular. Bladder appearance was not associated with presence of prenatal megacystis, abnormal DMSA scan, VUR, nor rate of fUTI. The only significant associations were normal/regular bladder and early prenatal diagnosis (p = 0.04) and normal/regular bladder and elevated nadir creatinine (>75µmol/l) (p = 0.01).DiscussionWe believe that when focusing solely on the appearance of the bladder, excluding information about the urethra and presence of reflux, the cystogram alone is insufficient to inform on future bladder function. This could be used as an argument in favor of performing early urodynamics in this population.

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Predicting the Future of Patients with Obstructive Uropathy—A Comprehensive Review

et al. 2022

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Nadir creatinine predicts long-term bladder function in boys with posterior urethral valves

Cited by 7 publications

References 12 publications

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

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

Appearance of the bladder on initial voiding cystogram in boys with PUV and its relation to pre and postnatal findings

Predicting the Future of Patients with Obstructive Uropathy—A Comprehensive Review

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