Progression to end-stage renal disease in children with posterior urethral valves

Abstract

Diagnostic and therapeutic strategies in boys with congenital posterior urethral valves (PUV) have much improved in past decades, but the impact of these changes on the progression to end-stage renal disease (ESRD) has rarely been investigated. We followed renal function in 20 boys with PUV from diagnosis to ESRD. From the first observation period (1969-1978) to the second period (1979-1992) we found a marked drop in age at diagnosis, at valve resection, at first increase of serum creatinine (SCr), and at onset of ESRD. The progression was analyzed by calculating the slope of 1/SCr and the probability of renal survival. In all patients combined, renal survival at the age of 10 years was 35%. In children undergoing valve resection in the 1st year of life, renal survival was worse than in those undergoing later surgery (15% vs. 65% after 10 years, P=0.006). Patients with a SCr>1.2 mg/dl before the age of 12 months progressed more rapidly to ESRD than those attaining this level later. The lower the minimum level of SCr observed after initial surgery, the older the patient at the onset of ESRD. The presence of renal dysplasia or hypoplasia, but not of vesicoureteric reflux, was associated with a more rapid progression. Mean body height at ESRD was -2.3+/-1.3 standard deviation score compared with controls, and was lower if PUV was diagnosed before the age of 6 months.

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

“…Previous reports have consistently identified a number of other clinical characteristics associated with a poor outcome in these boys, including delayed diagnosis and surgical intervention [36,37], the presence of high-grade VUR [10,14], impaired kidney function when evaluated postnatally at various times [12,38], and an elevated nadir serum creatinine [39]. We also found that upper tract diversion was associated with a poor outcome.…”

Predictive value of serum creatinine in patients with posterior urethral valve

“…There are conflicting evidence about the prognostic value of sCr before and after bladder catheterization. Some suggested more accurate prognostic value of sCr at 1 year after decompression than the initial values (14). However, sCr before bladder catheterization was significatly associated with ESRD, rather than after bladder decompression in our study (3).…”

“…(d) sCr after valve ablation has a high prognostic value for prediction of final renal outcome (5). sCr values after urinary catheterization was higher in males who developed decreased renal function than those who did not (7). Creatinine velocity as the rate of sCr following initial bladder drainage is a recently introduced predictor of CKD in neonates with PUV (13).…”

α-Tocopherol modulates lipoprotein cytotoxicity in obstructive nephropathy

“…With α-tocopherol supplementation, the MDA content decreased to 88.0±5.7 µM (P=0.28). Figure 4 shows that the TGFβ1 mRNA, normalized to cyclophilin, was elevated (0.98±0.04 ADU) in the ate surgical procedure to relieve ureteral obstruction, performed shortly after birth, has made no significant difference in elapsed time from diagnosis to dialysis and renal transplantation [22][23][24][25][26]. Intrauterine surgical correction of this condition is difficult and costly.…”