551 RENAL FAILURE IN CHILDREN WITH POSTERIOR URETHRAL VALVES (PUV): DID ADDITIONAL INTERVENTIONS IMPACT PROGRESSION TO END STAGE RENAL DISEASE (ESRD)?

Abstract

You have accessJournal of UrologyPediatrics: Congenital Anomalies - Lower Urinary Tract & Genitalia1 Apr 2011551 RENAL FAILURE IN CHILDREN WITH POSTERIOR URETHRAL VALVES (PUV): DID ADDITIONAL INTERVENTIONS IMPACT PROGRESSION TO END STAGE RENAL DISEASE (ESRD)? Fouad Alkawai, Yaser El-Hout, Diane Hebert, Armando J. Lorenzo, Darius J. Bagli, Joao L. Pippi Salle, and Walid A. Farhat Fouad AlkawaiFouad Alkawai Toronto, Canada More articles by this author , Yaser El-HoutYaser El-Hout Toronto, Canada More articles by this author , Diane HebertDiane Hebert Toronto, Canada More articles by this author , Armando J. LorenzoArmando J. Lorenzo Toronto, Canada More articles by this author , Darius J. BagliDarius J. Bagli Toronto, Canada More articles by this author , Joao L. Pippi SalleJoao L. Pippi Salle Toronto, Canada More articles by this author , and Walid A. FarhatWalid A. Farhat Toronto, Canada More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1276AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although valve ablation is the standard surgical intervention in patients (pts) with PUV, high diversion is thought to halt progression to ESRD. Most previous studies were limited in reporting outcomes on heterogeneous pts. We assess the impact of different surgical interventions on clinical course of a homogenous group of pts with chronic kidney disease (CKD). METHODS Between 1982 and 2010, a single center retrospective review of the Nephrology Database for CKD and ESRD identified 41 pts with PUV out of total of 270 pts. Four pts were excluded for incomplete data. The remaining 37 pts were divided into 3 groups according to intervention: valve ablation alone (A), additional vesicostomy (A+V) or pyelostomies (A+P). Serum creatinine (Cr) and GFR (calculated by Schwartz formula) were recorded at presentation, nadir, worsening or last follow-up (F/U). Worsening was defined as at least CKD type 3 (GFR < 60 mL/min) or reaching ESRD (GFR < 15 mL/min and/or requiring renal replacement therapy). RESULTS Twelve pts (32%) had valve ablation alone, 16 (43%) had additional vesicostomy and 9 (25%) had additional pyelostomies (1/9 had also a prior vesicostomy). Mean age at first intervention was 26 months, 14.8 months and 1.5 months for the (A), (A+V) and (A+P) groups, respectively. In the (A) group, 1/12 pts presented with ESRD. Of the remaining 11 pts (initial Cr/GFR=242/33 and nadir Cr/GFR=128/72), 4 pts remain stable (nadir Cr/GFR= 63/106, mean F/U = 5 yrs) while 7 pts worsen (nadir Cr/GFR=180/43, mean F/U =6.8 yrs), of whom 6 progress to ESRD in mean of 1 yr. In the (A+V) group, of the 16 pts (initial Cr/GFR=281/44 and nadir Cr/GFR=126/73), 5 patients remain stable (nadir Cr/GFR= 79/104, mean F/U = 13.2 yrs) while 11 pts worsen (nadir Cr/GFR=147/70, mean F/U =5.2 yrs), of whom 7 progress to ESRD in mean of 2.3 yrs. In (A+P) group, 2/9 pts presented with ESRD. Of the remaining 7 pts (initial Cr/GFR=297/27 and nadir Cr/GFR=166/39), only 1 pt is stable (nadir Cr/GFR= 146/50, F/U = 3 yrs) while 6 pts worsen (nadir Cr/GFR=170/38, mean F/U =5.5 yrs), of whom 3 progress to ESRD in mean of 1.5 yrs. CONCLUSIONS The majority of pts with CKD type 3 or worse will have progression of renal failure, irrespective of the type of intervention, at comparable times of follow-up. Stability of renal function on last follow-up correlates with nadir Cr/GFR. Additional intervention may delay worsening in a subset of pts with nadir CKD 1 and 2. The effect of other variables, like bladder dynamics, needs to be further investigated. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChua M, Ming J, Carter S, El Hout Y, Koyle M, Noone D, Farhat W, Lorenzo A and Bägli D (2018) Impact of Adjuvant Urinary Diversion versus Valve Ablation Alone on Progression from Chronic to End Stage Renal Disease in Posterior Urethral Valves: A Single Institution 15-Year Time-to-Event AnalysisJournal of Urology, VOL. 199, NO. 3, (824-830), Online publication date: 1-Mar-2018. Volume 185Issue 4SApril 2011Page: e223 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Fouad Alkawai Toronto, Canada More articles by this author Yaser El-Hout Toronto, Canada More articles by this author Diane Hebert Toronto, Canada More articles by this author Armando J. Lorenzo Toronto, Canada More articles by this author Darius J. Bagli Toronto, Canada More articles by this author Joao L. Pippi Salle Toronto, Canada More articles by this author Walid A. Farhat Toronto, Canada More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...