Risk factors for renal insufficiency in children with urethral valves

Abstract

Posterior urethral valves (PUV) associated with renal dysplasia are one of the most common causes of end stage kidney disease (ESKD) in childhood. In order to identify risk factors for the progression of this condition to early renal failure, we have retrospectively analyzed the clinical course, renal function, and first postnatal renal ultrasound in a sample of 42 young male patients with PUV, who were followed at a single center. Twelve (28.6%) were diagnosed with ESKD at a median age of 11.3 years. Our comparison of PUV patients without decreased estimated glomerular filtration rate (eGFR) (group A; K/DOQI CKD stage 0-1) with PUV patients showing a decreased eGFR (group B; K/DOQI CKD stage 2-5) revealed the following significant risk factors for loss of eGFR: renal volume <3rd percentile (P < 0.001), elevated echogenicity (P = 0.001), pathologic corticomedullary differentiation (P < 0.001), >3 febrile urinary tract infections (P = 0.012), and decreased eGFR at 1 year of age (P < 0.001). Receiver operating characteristic curve analysis in the cohort confirms that patients showing a renal volume >88.2 ml/m(2) body surface area (BSA) are not at risk to develop K/DOQI CKD stage 5 (sensitivity 75%, specificity 77.3%, positive/negative predictive value 37.5/94.4%). Ultrasound promises to be a valuable tool for identifying endangered patients.

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

“…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.…”

“…Our findings also confirmed the value of postnatal kidney function estimates as predictors of long-term outcome in our cohort. In particular, a lower estimated GFR one year was associated with worse long-term outcome [15,40], and eGFR best values <60 ml/min/1.73 m 2 were associated with significantly worse ESRD-free survival. These results also emphasize the importance of prenatal kidney injury in the pathogenesis of progressive renal failure [30,41,42,43,44].…”

Abdominal distention and renal failure in a neonate

“…Several factors have been described which appear to influence the likelihood of development of ESRD in patients with PUV 14 17. Pohl et al compared a group of 19 patients with PUV who developed ESRD with a group of 23 patients with PUV who had normal estimated glomerular filtration rate (eGFR) during a median follow-up period of more than 5 years in both groups.…”

Valve bladder syndrome in children: On the trail of the best strategies to prevent chronic kidney disease

“…The clear rules of antibiotic preventive therapy has not been established, some recommend trimethoprim 1-2 mg nightly dose until vesicoureteral reflux recedes or age of 4-5 years. 10,37 Interestingly, many authors quote arguments of the positive effects of circumcision in UTI prevention in children with PUV; 11,37 • some other methods for reducing urinary retention in the bladder include pelvic floor muscles exercise and Valsalva maneuver. 10,18 When all of the methods mentioned above are insufficient in reducing urine retention and improving bladder voiding, surgical procedures are performed:…”