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Progression to end-stage renal disease in children with posterior urethral valves
1Division of Pediatric Nephrology, Children's Hospital, University of Heidelberg, Germany.
Insights
Congenital posterior urethral valves (PUV) impact renal survival, with earlier diagnosis and surgery not improving outcomes. Early elevated creatinine and renal dysplasia predict faster progression to end-stage renal disease (ESRD).
Area of Science:
- Pediatric Nephrology
- Urology
- Renal Disease Research
Background:
- Congenital posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in male infants.
- Advances in diagnostic and therapeutic strategies for PUV have occurred over recent decades.
- The long-term impact of these advancements on the progression to end-stage renal disease (ESRD) remains under-investigated.
Purpose of the Study:
- To investigate the impact of diagnostic and therapeutic changes on renal function progression in boys with PUV.
- To analyze the factors influencing the rate of progression to ESRD in this patient cohort.
- To assess renal survival rates and associated clinical parameters in boys with PUV.
Main Methods:
- A retrospective study following 20 boys with PUV from diagnosis to ESRD.
- Analysis of renal function progression using the slope of 1/serum creatinine (SCr) and renal survival probability.
- Comparison of outcomes between different observation periods and surgical timing.
Main Results:
- A significant decrease in age at diagnosis, valve resection, and onset of ESRD was observed between 1969-1978 and 1979-1992.
- Overall renal survival at 10 years was 35%.
- Earlier valve resection (within the first year of life) was associated with worse renal survival (15% vs. 65% after 10 years, P=0.006).
- Higher SCr levels before 12 months and the presence of renal dysplasia/hypoplasia predicted more rapid ESRD progression.
- Lower minimum SCr post-surgery correlated with older age at ESRD onset.
- Mean height at ESRD was significantly reduced, particularly with early PUV diagnosis.
Conclusions:
- Despite improved diagnostic and therapeutic timing, early intervention in PUV does not necessarily improve renal survival.
- Early elevated serum creatinine and renal dysplasia are critical indicators of poor renal prognosis.
- Optimal management strategies require further investigation to improve long-term renal outcomes in boys with PUV.
Abstract:
Diagnostic and therapeutic strategies in boys with congenital posterior urethral valves (PUV) have much improved in past decades, but the impact of these changes on the progression to end-stage renal disease (ESRD) has rarely been investigated. We followed renal function in 20 boys with PUV from diagnosis to ESRD. From the first observation period (1969-1978) to the second period (1979-1992) we found a marked drop in age at diagnosis, at valve resection, at first increase of serum creatinine (SCr), and at onset of ESRD. The progression was analyzed by calculating the slope of 1/SCr and the probability of renal survival. In all patients combined, renal survival at the age of 10 years was 35%. In children undergoing valve resection in the 1st year of life, renal survival was worse than in those undergoing later surgery (15% vs. 65% after 10 years, P=0.006). Patients with a SCr>1.2 mg/dl before the age of 12 months progressed more rapidly to ESRD than those attaining this level later. The lower the minimum level of SCr observed after initial surgery, the older the patient at the onset of ESRD. The presence of renal dysplasia or hypoplasia, but not of vesicoureteric reflux, was associated with a more rapid progression. Mean body height at ESRD was -2.3+/-1.3 standard deviation score compared with controls, and was lower if PUV was diagnosed before the age of 6 months.