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Progression to end-stage renal disease in children with obstructive uropathy
Insights
Obstructive uropathy can lead to end-stage renal disease (ESRD) even after early intervention and surgery. Long-term monitoring is crucial for young patients with obstructive uropathy to track kidney function progression.
Area of Science:
- Pediatric Nephrology
- Urology
Background:
- Obstructive uropathy is a significant cause of end-stage renal disease (ESRD) in children.
- Early signs of obstructive uropathy often appear within the first year of life.
Purpose of the Study:
- To review the clinical course of patients with ESRD secondary to obstructive uropathy.
- To understand the long-term renal outcomes in children with obstructive uropathy.
Main Methods:
- Retrospective review of 54 patients (35 boys, 19 girls) with ESRD from obstructive uropathy.
- Analysis of age at initial sign of obstructive uropathy, onset of ESRD, and time to dialysis.
Main Results:
- Mean age at initial sign of obstructive uropathy was 3.5 years; 41% presented in the first year of life.
- Mean age at ESRD onset (dialysis) was 12.2 years, with a mean 9-year interval from initial sign to dialysis.
- ESRD progression occurred in 14 patients operated on before age one, with a mean of 10 years post-surgery.
Conclusions:
- Progression to ESRD can occur despite appropriate surgical management for obstructive uropathy.
- Prolonged follow-up is essential for assessing renal function outcomes in young patients with obstructive uropathy.
- Early intervention does not always prevent eventual ESRD in obstructive uropathy cases.
Abstract:
The course of 54 patients (35 boys and 19 girls) with end-stage renal disease resulting from obstructive uropathy was reviewed. The mean age at the initial sign of obstructive uropathy was 3.5 years. Twenty-two patients (41%) manifested evidence of obstructive uropathy during the first year of life. The mean age at the time of onset of ESRD (dialysis) was 12.2 years and was similar in boys and girls. The mean time interval between the first sign of obstructive uropathy and the initiation of dialysis was nine years. Fourteen patients operated upon at less than one year of age developed ESRD one to 20 years (mean ten years) following their initial surgery. Progression to ESRD occurred despite appropriate surgical management, including corrective as well as diversionary urologic procedures. However, because the patients were selectively referred for care of ESRD, no assessment of the incidence of ESRD caused by obstructive uropathy was possible. The data indicate that prolonged follow-up periods are necessary to assess the ultimate outcome of renal function in young patients with obstructive uropathy. Despite early intervention and intact renal function for many years during childhood, progression to ESRD may occur.