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Mid-short-term risk factors for chronic renal failure in children with posterior urethral valve

Wei Zhang1,2, Pin Li3, Huixia Zhou4,5

  • 1The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.

Pediatric Surgery International
|July 2, 2022
PubMed

Insights

Late valve ablation and high detrusor pressure are key risk factors for chronic renal failure in children with posterior urethral valve. Monitoring these can help predict kidney function prognosis.

Area of Science:

  • Pediatric Urology
  • Nephrology
  • Surgical Outcomes

Background:

  • Posterior urethral valve (PUV) is a common congenital anomaly in male infants.
  • Valve ablation is the primary treatment, but chronic renal failure (CRF) remains a significant complication.
  • Identifying early risk factors is crucial for improving long-term renal outcomes.

Purpose of the Study:

  • To investigate the mid-short-term risk factors for developing chronic renal failure (CRF) in pediatric patients following posterior urethral valve (PUV) ablation.
  • To identify specific clinical parameters associated with increased risk of CRF post-ablation.

Main Methods:

  • Retrospective analysis of 143 pediatric patients with PUV who underwent valve ablation.
  • Patients were categorized into CRF and non-CRF groups based on renal function post-surgery.
  • Key clinical data including age at first/last resection, number of operations, maximal detrusor pressure (Pdetmax), and vesicoureteral reflux (VUR) were collected and analyzed.

Main Results:

  • Patients in the CRF group had a significantly later age at last resection and higher maximal detrusor pressure (Pdetmax) compared to the non-CRF group (P < 0.05).
  • Multiple regression analysis identified last resection age (β=1.034) and Pdetmax (β=1.068) as independent risk factors for CRF.
  • A Pdetmax cutoff of 41.65 cmH2O and a last resection age of 35.5 months were associated with increased CRF risk.

Conclusions:

  • Delayed valve ablation (indicated by last resection age) and elevated maximal detrusor pressure (Pdetmax) are significant risk factors for chronic renal failure in children with PUV.
  • A Pdetmax below 41.65 cmH2O suggests a favorable prognosis for renal function in these patients.
  • These findings highlight the importance of timely intervention and management of detrusor pressure to preserve renal function in children with PUV.
Abstract

Keywords:
Chronic renal failure (CRF)Maximal detrusor pressure (Pdetmax)Posterior urethral valve (PUV)Resection ageVesicoureteral reflux (VUR)

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