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Prognostic factors in prenatally-detected posterior urethral valves: a multivariate analysis
Eduardo A Oliveira1, Eli A S Rabelo, Alamanda K Pereira
1Pediatric Nephrourology Unit, Department of Pediatrics, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. eduolive@medicina.ufmg.br
Insights
Oligohydramnios, ventilatory support, high urea levels, and bilateral vesicoureteral reflux (VUR) predict chronic renal failure in children with posterior urethral valves (PUV). Unilateral VUR may be protective.
Area of Science:
- Pediatric Nephrology
- Urology
- Medical Research
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
- Chronic renal insufficiency is a significant complication of PUV, impacting long-term health.
- Identifying early prognostic factors is crucial for timely intervention and management.
Purpose of the Study:
- To determine prognostic factors associated with the development of chronic renal insufficiency in children diagnosed with posterior urethral valves (PUV).
- To identify predictors of adverse outcomes in a pediatric cohort with PUV.
Main Methods:
- A prospective study followed 22 children with PUV for a median of 76 months.
- Prognostic factors were assessed using fetal echography, clinical findings, and laboratory data upon admission.
- Univariate analysis (Kaplan-Meier) and multivariate analysis (Cox model) were employed to identify independent predictors.
Main Results:
- Fifty percent (11/22) of patients developed chronic renal failure (CRF) during follow-up.
- Independent predictors of adverse outcomes included oligohydramnios (RR=10.6), ventilatory support (RR=6), urea > 40 mg/dl (RR=3.7), and bilateral vesicoureteral reflux (VUR) (RR=6.1).
- Unilateral VUR was identified as a protective factor against CRF or death (RR=0.92).
Conclusions:
- Oligohydramnios, need for ventilatory support, elevated urea levels, and bilateral VUR are significant independent predictors of chronic renal failure in children with PUV.
- The presence of unilateral VUR may indicate a better prognosis, potentially acting as a protective factor.
- These findings aid in risk stratification and personalized management strategies for pediatric PUV patients.
Abstract:
To identify prognostic factors associated with chronic renal insufficiency in children with posterior urethral valves (PUV), 22 children with PUV were submitted to a systematic protocol and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings were studied on admission. Median follow-up was 76 months. The analysis was conducted in two steps: in univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis using the Cox model. Eleven patients (50%) developed chronic renal failure (CRF) during follow-up. After adjustment by the multivariate model, four factors were identified as independent predictors of adverse outcome: oligohydramnios (relative risk [RR] = 10.6, 95% CI = 2.7 - 77, P = 0.02), ventilatory support (RR = 6, 95% CI = 2 - 24, P = 0.01), urea higher than 40 mg/dl (RR = 3.7, 95% CI = 0.92 - 15.0, P = 0.06), and bilateral vesicoureteral reflux (VUR) (RR = 6.1, 95% CI = 1.25 - 30, P = 0.02). On the other hand, the presence of unilateral VUR was a protective factor against the development of CRF or death during follow-up (RR = 0.92, 95% CI = 0.87 - 0.98, P = 0.05).