Renal impairment in children with posterior urethral valves

Kari, Jameela A.; El-Desoky, Sherif M.; Farag, Youssef M.K.; Mosli, Hisham A.; Altyieb, Abdul-Malik; Sayad, Ahmad Al; Radawi, Othman; Ghabra, Hosam; Basnawi, Faten; Bahrawi, Ohood; Singh, Ajay K.; Farsi, Hasan M.

doi:10.1007/s00467-012-2390-7

Cited by 16 publications

(17 citation statements)

References 23 publications

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“…Fetal lower urinary tract obstruction (LUTO) is an obstructive uropathy at the level of the neck of the bladder, caused by different entities such as posterior urethral valves (PUV), urethral atresia (UA), and urethral stenosis (US) . It occurs in approximately two out of 10 000 births and is associated with a high perinatal mortality and morbidity due to pulmonary hypoplasia and renal dysfunction . Relief of the urinary obstruction by prenatal vesicoamniotic shunting (VAS) is commonly offered because it may reduce the postnatal mortality .…”

Section: Introductionmentioning

confidence: 99%

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

et al. 2016

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Objectives Our objective is to report long-term outcome after fetal cystoscopy for lower urinary tract obstruction (LUTO), as well as to investigate the accuracy of fetal cystoscopy in diagnosing the cause of bladder outlet obstruction.Methods This is a retrospective cohort study of all fetuses who underwent cystoscopy for prenatal diagnosis of LUTO in three tertiary referral centers. Fetal diagnostic cystoscopy was performed to determine prenatally the cause of LUTO and to ablate the posterior urethral valves (PUV).Results A total of 50 fetal cystoscopies were performed, revealing PUV in 31 (62%) fetuses, urethral atresia (UA) in 14 (28%) fetuses, and urethral stenosis (US) in 5 (10%) fetuses. Two fetuses had trisomy 18 diagnosed after fetal cystoscopy and were excluded from the present analysis. Fetal cystoscopy was accurate in the diagnosis of the etiology of LUTO in 32/35 (91.4%). There were no survivors in the UA group. One fetus with US underwent urethral stenting and survived with normal renal function at 2 years of life. Among the infants with PUV, 17/30 (56.7%) infants survived, and 13/17 (76.5%) had normal renal function at 1 year of life; 15/28 (53.6%) infants survived, and 11/15 (73.3%) had normal renal function at 2 years.Conclusions Fetal cystoscopy is accurate in the diagnosis of the etiology of LUTO and serves as a guide to the specific prenatal treatment. This procedure is associated with modest long-term survival (54%) but with adequate preserved normal renal function in two thirds of the infants among fetuses with PUV.

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Section: Introductionmentioning

confidence: 99%

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

et al. 2016

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“…Fetal lower urinary tract obstruction (LUTO) occurs in approximately 2.2 of every 10 000 births. Severe LUTO with bladder outlet obstruction is often diagnosed during the first trimester of pregnancy and is associated with high perinatal mortality due to pulmonary hypoplasia and severe renal impairment or damage. Vesicoamniotic shunting is a treatment option for relief of the urinary obstruction associated with severe LUTO but this procedure is associated with complications such as migration, obstruction and displacement of the shunt tubing.…”

Section: Introductionmentioning

confidence: 99%

Urological fistulas after fetal cystoscopic laser ablation of posterior urethral valves: surgical technical aspects

Sananès

Favre

Koh

et al. 2015

Ultrasound in Obstet & Gyne

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Objective To describe the surgical technical aspects associated with the development of urological fistulas after fetal antegrade cystoscopic laser fulguration of the posterior urethral valves (PUV). Methods (P < 0.01) and with the use of semi-curved rather than curved sheaths (P < 0.01), the use of a diode laser (P < 0.01) and the use of higher laser power and energy (P < 0.01 and P < 0.01, respectively), as well as with less operator experience (P < 0.01) and with absence of fetal anesthesia/immobilization (P = 0.02). Conclusion

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“…These methods avoid the problem that results from logistic regression analyses of a dichotomous outcome (ESRD versus no ESRD) (9,11,12) by not assuming that patients who were lost to follow-up, or who had short follow-up, had similar kidney outcomes as those patients who were followed throughout the study. However, our study has limitations.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reports suggested that nadir creatinine predicts the risk of kidney failure in children with PUV. However, the clinical applicability of these prior observations to the infant with PUV is confusing given the wide range of ages at presentation and different definitions of nadir creatinine used (9)(10)(11)(12)(13)(14). New prognostic indicators are needed to improve counseling and identify the patients in whom referral to a pediatric nephrologist and early interventions to slow the progression of kidney failure would be most likely to have the greatest efficacy.…”

Section: Introductionmentioning

confidence: 99%

Renal Parenchymal Area and Risk of ESRD in Boys with Posterior Urethral Valves

Pulido¹,

Furth

Zderic

et al. 2014

Clinical Journal of the American Society of Nephrology

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Background and objectives Approximately 20% of boys with posterior urethral valves develop ESRD; however, few factors associated with the risk of ESRD have been identified. The objective of this study was to determine if renal parenchymal area, defined as the area of the kidney minus the area of the pelvicaliceal system on first postnatal ultrasound, is associated with the risk of ESRD in infants with posterior urethral valves.Design, setting, participants, & measurements A retrospective cohort of boys who were diagnosed with posterior urethral valves at less than 6 months of age between 1988 and 2011 and followed for at least 1 year at a freestanding children's hospital was assembled. Cox proportional hazard regression and Kaplan-Meier analysis were used to estimate the association between renal parenchymal area and time to ESRD. Cox models were adjusted for age at presentation, minimum creatinine 1 month after bladder decompression, and vesicoureteral reflux.Results Sixty patients were followed for 393 person-years. Eight patients developed ESRD. Median renal parenchymal area was 15.9 cm 2 (interquartile range=13.0-21.6 cm 2 ). Each 1-cm 2 increase in renal parenchymal area was associated with a lower risk of ESRD (hazard ratio, 0.64; 95% confidence interval, 0.42 to 0.98). The rate of time to ESRD was 10 times higher in boys with renal parenchymal area,12.4 cm 2 than boys with renal parenchymal area$12.4 cm 2 (P,0.001). Renal parenchymal area could best discriminate children at risk for ESRD when the minimum creatinine in the first 1 month after bladder decompression was between 0.8 and 1.1 mg/dl. ConclusionIn boys with posterior urethral valves presenting during the first 6 months of life, lower renal parenchymal area is associated with an increased risk of ESRD during childhood. The predictive ability of renal parenchymal area, which is available at time of diagnosis, should be validated in a larger, prospectively-enrolled cohort.

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Renal impairment in children with posterior urethral valves

Abstract: Ablation of PUV or vesicostomy did not influence kidney function in our study cohort. Children with a normal nadir serum creatinine who presented early had a better outcome.

Cited by 16 publications

References 23 publications

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

Two‐year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction

Urological fistulas after fetal cystoscopic laser ablation of posterior urethral valves: surgical technical aspects

Renal Parenchymal Area and Risk of ESRD in Boys with Posterior Urethral Valves

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