Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia

Abstract

Background: Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys. It is considered that early diagnosis and intervention have good outcomes in terms of renal function, though the varying extent of embryological insult requires these boys to remain in extended follow-up and care. Objective: To assess the renal outcome of patients following PUV ablation. Methods: This was a descriptive retrospective study. Data were collected from the operation logbooks of patients from 2015 to 2019 that had been admitted to the Tikur Anbessa Specialized Hospital pediatric surgery unit with a working diagnosis of PUV and had ablation done primarily or following diversion. Data were collected from January to April 2020 and analyzed using SPSS 25. P value≤0.05 was considered significant. Results: Seventy patients were analyzed and followed for 3 years for the development of postoperative chronic kidney disease (CKD) after PUV ablation. Postoperative CKD was found in 52.9% of patients and end-stage renal disease in 2.9%. Risk factors associated with postoperative CKD were the presence of preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine. Results also showed that a delay between the development of vesicostomy and ablation had a significant correlation with renal outcome. Elevated nadir serum creatinine, postoperative proteinuria, and delay between the development of vesicostomy and ablation were found to be independent risk factors of development of CKD. Conclusion:There was a high rate of CKD development in patients who had had ablation for PUV, which was comparable to other studies. Three variables were found to be independent risk factors for the progression of CKD, unlike other findings seen in low-and middle-income countries.

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

“…Five studies analyzed the association between nadir creatinine and the development of CKD ( 27 , 29 , 33 , 34 , 36 ), five studies analyzed the association between nadir creatinine and the development of ESKD ( 26 , 30 , 31 , 32 , 35 ), and remaining three studies analyzed the association between nadir creatinine and the development of CKD and ESKD separately ( 28 , 37 , 38 ).…”

“…Eleven studies performed a multivariable analysis to screen potential confounders with the common result that nadir creatinine was an independent factor for the development of CKD. Other prognostic factors identified were proteinuria ( 27 , 37 ), mild-to-severe bladder dysfunction ( 26 , 31 , 32 ), baseline creatinine ( 28 , 37 , 38 ), hypertension ( 37 ), recurrent urinary tract infection (UTI), polyuria ( 32 ), delay of intervention ( 27 ), high-grade vesico-ureteral reflux (VUR), prenatal diagnosis, renal echography abnormality, prematurity ( 28 ), creatinine at 6 weeks from the surgical ablation ( 38 ), and mechanical ventilation ( 30 ).…”

“…After screening the titles and abstracts, we identified 24 studies for full-text review. Following a full-text review and the manual search of the articles included in the reference lists, we identified 13 eligible studies meeting our inclusion criteria, which were included in the review and are presented in Table 1 (26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38).…”

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

“…Proteinuria is a common marker in nephrology that is used to assess kidney damage. Several studies have identified proteinuria as a negative prognostic marker for renal outcome in PUV patients [ 36 , 62 , 66 , 67 ]. Some studies have shown that urinary markers of inflammation and fibrotic remodelling can predict renal outcome.…”

Trends of Oat Production Area, Productivity and Utilization Status in Ethiopia

“…Lulseged (1987) also stated that oat is a dual purpose forage crop which can also be used as human food in many parts of the world. According to the Ethiopia Ministry of agriculture and rural development, oats was registered as grass and used as forages (Getnet, 2012). Oats are abundantly grown in the central highlands of Selale and some parts of west Shewa like Meta-Robi and Galessa areas of Dendi woreda, Arsi, Bale and Gojjam.…”