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

Polak−Jonkisz, Dorota; Rehan, Leopold; Fornalczyk, Konstancja; Hackemer, Paweł; Zwołińska, Danuta

doi:10.17219/acem/65782

Cited by 4 publications

(4 citation statements)

References 35 publications

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“…In the presented patient during urethrocystoscopy, performed at the age of 7, PUV were revealed and incised. PUV were categorized by Young in 1919 into 3 types: the most common type I (95%), where folds originate from the distal edge of colliculus, type II of only historical significance, and type III (5%) with the worst prognosis, where membrane with a central hole is not linked with colliculus [5]. In the presented patient the most common type I of PUV was diagnosed, which is not surprising in the context of the relatively mild clinical presentation.…”

Section: Discussionmentioning

confidence: 79%

“…Such changes are the risk factors of dilatation of the upper urinary tract and kidney failure. VBS in urodynamic studies presents as bladder overactivity, poor compliance, and myogenic failure [5]. All of these symptoms may be found in subsequent urodynamic studies in the presented patient consequently leading to dilatation and deformation of the pelvicalyceal system of the right kidney in the last US.…”

Section: Discussionmentioning

confidence: 88%

“…The main consequences of urethra obstruction caused by PUV are detrusor hypertrophy, urinary bladder wall trabeculation, and ureterohydronephrosis. All of these problems may lead to VUR, obstructive nephropathy, chronic pyelonephritis, and chronic kidney disease (CKD) [5] in 20 -65%of all cases of which 8-21% will progress to end-stage renal disease (ESRD) [6,7]. PUV are usually suspected on the routine prenatal US showing dilation of the posterior urethra, thickening of the urinary bladder wall ("keyhole" sign), and upper urinary tract dilation (megaureters and hydronephrosis).…”

Section: Introductionmentioning

confidence: 99%

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Late diagnosis of posterior urethral valves: a case report and the literature review

Szawłoga

Sobieszczańska-Droździel

2022

J Educ Health Sport

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Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in boys. They are usually suspected antenatally or soon after the birth as the cause of severe hydronephrosis, oligohydramnios, renal hypodysplasia, and kidney failure. In milder forms of PUV, the uncharacteristic symptoms occur later in childhood, adolescence, or even adulthood and cause diagnostic problems. The final diagnosis and causative treatment of PUV are possible due to cystourethroscopy. Nevertheless, as a consequence of the defect, valve bladder syndrome (VBS) occurs and requires long-term treatment. The authors present a case of a 14-year-old boy with a late diagnosis of PUV at the age of 7. Recurrent pyelonephritis and nonspecific voiding dysfunction were the first symptoms. Ultrasounds(US) were initially normal while videocystometry(VCM) showed the 3rd-grade right-sided vesicoureteral reflux (VUR), bladder diverticulum as well as discrete detrusor overactivity, and reduced bladder capacity without any signs of bladder obstruction. Bilateral post-inflammatory nephropathy completed the clinical picture. In urethrocystoscopy surprisingly PUV were found and incised. Due to recurrent urinary tract infections (UTIs) one year later the STING procedure was performed which resulted in the resolution of VUR. Despite this, the features of bladder dysfunction, requiring regular urodynamic evaluation and pharmacotherapy, persisted. Recurrent UTIs in boys may suggest urinary tract obstruction and PUV should be considered regardless of the patient's age. Early diagnosis and appropriate management may improve the prognosis.

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Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Late diagnosis of posterior urethral valves: a case report and the literature review

Szawłoga

Sobieszczańska-Droździel

2022

J Educ Health Sport

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“…Endoscopic resection of PUVs is the initial treatment in most patients; more rarely, an early temporary urinary diversion is required ( 9 – 12 ). Despite improving surgical techniques and early diagnosis, the renal outcome has poorly improved over time ( 13 – 15 ). Many prognostic factors have been analyzed both in prenatal and postnatal ages to identify children with PUVs at increased risk of progression to ESKD and dialysis.…”

Section: Introductionmentioning

confidence: 99%

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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Posterior Urethral Valves with Lower Urinary Tract Symptoms: Perspective on Urodynamics

Tang

Fan

et al. 2020

Journal of Investigative Surgery

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

Cited by 4 publications

References 35 publications

Late diagnosis of posterior urethral valves: a case report and the literature review

Late diagnosis of posterior urethral valves: a case report and the literature review

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

Posterior Urethral Valves with Lower Urinary Tract Symptoms: Perspective on Urodynamics

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