Evaluation of polyuria and polydipsia along with other established prognostic factors in posterior urethral valves for progression to kidney failure: experience from a developing country

Kumar, Naveen; Yadav, Priyank; Jain, Shrey; G, Abhay Kumar; Kaushik, Vinay N.; Ansari, M. Sib

doi:10.1007/s00467-020-04837-4

Cited by 4 publications

(4 citation statements)

References 37 publications

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

“…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 ).…”

Section: Resultsmentioning

confidence: 99%

“…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).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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BackgroundPosterior urethral valves (PUVs) represent the most severe pediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%–21% of patients. Unfortunately, renal outcomes have poorly improved over time. The key point is to identify patients at risk; thus, several prenatal and postnatal prognostic factors have been analyzed to improve clinical outcomes. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding.ObjectiveWe performed a systematic review with meta-analysis to analyze the predictive value of nadir creatinine on long-term renal function in infants with PUVs.MethodsWe conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps.ResultsA total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analyzed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35–25.17, I2 = 92.20%, p < 0.001).ConclusionsNadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

et al. 2023

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“…Urinary tract infections (UTI) can result from bladder dysfunction or vesicoureteral reflux, and can scar kidney tissue through inflammatory processes. Two studies were able to show that the number of urinary tract infections worsens renal prognoses [ 60 , 61 ], while another study was not able to prove any influence of UTI [ 62 ]. In a recent randomized controlled trial that compared antibiotic prophylaxis with and without circumcision in PUV patients, it was shown that the risk for febrile urinary tract infections could significantly be decreased by circumcision [ 63 ].…”

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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Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients

Huang,

Behairy,

Abelson

et al. 2023

Pediatr Nephrol

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Evaluation of polyuria and polydipsia along with other established prognostic factors in posterior urethral valves for progression to kidney failure: experience from a developing country

Cited by 4 publications

References 37 publications

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

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

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

Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients

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