Abnormal Antenatal Sonogram: An Indicator of Disease Severity in Children with Posterior Urethral Valves

Abstract

PUV represents a spectrum of disease severity. A normal prenatal ultrasound does not preclude PUV. The majority of patients with a normal prenatal examination have good outcomes. The OR suggests that there may be increased risk for poor outcome in those with an abnormal prenatal examination. A multicenter study is necessary to obtain a larger sample size and more precise ORs.

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

“…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]. …”

“…A limited number of previous studies have described the association of antenatal features with postnatal kidney function parameters in boys with PUV [12,17,18,19,20,21,22,23,24,25,26,27,28,29,30]. However, as highlighted in a recent systematic review, the ability to draw associations from these studies is severely hampered by a number of issues including the broad heterogeneity of the studies, the retrospective and small sample sizes, the biased cases selections, the variable postnatal follow-up periods, and most importantly the lack of standardized and consistent long-term kidney outcome measures [31].…”

“…Severe antenatal kidney injury due to PUV affects normal nephron endowment and contributes to the progression of CKD in those who survive the neonatal period [11,30,41,42,43,44]. Antenatal screening, with a focus on amniotic fluid volume and renal parenchymal changes, informs antenatal counseling regarding long-term postnatal kidney function.…”

Posterior urethral valves: Determinants of outcome in a developing country

“…Recent studies indicate that pre‐natal detection of PUV has significantly improved over the past decades with more than 70% of cases detectable by this mode currently . Pre‐natal diagnosis is achieved by ultrasound evaluation of fetal urinary tract and chemical analysis of fetal urine.…”

“…Early diagnosis and intervention to reduce urostasis and to stabilize upper tract is important to delay or prevent progression of renal insufficiency . Over the past decades, there has been a significant advance in achieving earlier detection of the disease and an improvement in the modalities of definitive treatment and renal support and replacement procedures . Despite these advances, long‐term renal and bladder dysfunction still remain a problem in a subset of children with PUV …”