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Outcome of posterior urethral valve in 64 children: a single center's 22-year experience
Mehtap Ezel Çelakil1, Zelal Ekinci2, Burcu Bozkaya Yücel2
1Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, İzmit, Turkey - mehtapcelakil@yahoo.com.
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Posterior urethral valve (PUV) significantly risks chronic kidney disease (CKD) in boys. Early antenatal diagnosis and managing hypertension and proteinuria can improve renal outcomes, though kidney injury remains a concern.
Area of Science:
- Pediatric Urology
- Nephrology
- Congenital Anomalies
Background:
- Posterior urethral valve (PUV) is a severe congenital anomaly of the kidney and urinary tract (CAKUT) in boys.
- PUV poses a significant risk for developing chronic kidney disease (CKD).
Purpose of the Study:
- To present long-term outcomes in children diagnosed with PUV.
- To identify risk factors influencing renal outcomes in pediatric PUV patients.
Main Methods:
- Retrospective chart review of 113 children with PUV from 1996-2018.
- Analysis of clinical, laboratory, and epidemiological data to determine impact on renal outcome.
Main Results:
- Median follow-up was 70 months; 35.9% developed CKD, with 10.9% reaching end-stage renal disease (ESRD).
- Hypertension, proteinuria, and high initial creatinine were significant CKD risk factors.
- Antenatal diagnosis was associated with a lower risk of CKD, while VUR and UTI showed less impact than expected.
Conclusions:
- PUV presents a substantial risk for CKD development in children.
- Antenatal detection and management of hypertension and proteinuria are crucial for modifying CKD progression.
- Further research is needed to assess interventions' long-term impact on renal outcomes.
Background:
Posterior urethral valve (PUV) is the most serious form of congenital anomalies of kidney and urinary tract (CAKUT) in boys with significant risk of progression to chronic kidney disease (CKD). We present our long-term results in children with PUV.
Methods:
Retrospective chart review of 113 children with PUV followed within the years of 1996-2018 was performed. Clinical, laboratory and epidemiologic parameters were analyzed for their impact on renal outcome.
Results:
The median age of diagnosis was 1.00 month (1.00-132.00) and the median follow-up period was 70 months (60.00-216.00). Antenatal diagnosis was present in 33 patients (51.5%) mainly with bilateral hydronephrosis and oligohydramnios. The most common postnatal presentation was recurrent urinary tract infection (UTI) in 14 cases (21.9%) and incontinence in three cases (4.7%). Vesicoureteral-reflux (VUR) was present in 31 cases (48.4%). All patients had surgery and urinary diversion was needed in 18 (28.2%). Varying stages of chronic kidney disease (CKD) developed in 23 cases (35.9%) and rise in serum creatinine was especially prominent after the 4th year of follow-up. Of 23 CKD patients, seven (10.9%) were in ESRD and on dialysis. Mortality occurred in one (1.5%) patient. Hypertension, proteinuria and high initial serum creatinine (>1.28 mg/dL) were statistically significant risk factors for CKD, as expected. Surprisingly VUR and UTI did not show such a significant impact on CKD development. Antenatal detection was with significantly less risk for CKD.
Conclusions:
Our results confirm that PUV has a considerable risk for CKD development. Antenatal diagnosis, management of proteinuria and hypertension may modify this progression. But already injured kidneys still have a potential risk. The need for further research to evaluate the impact of any intervention on long term renal outcome is obvious.
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