MP54-01 SIGNIFICANT PREDICTORS OF CHRONIC KIDNEY DISEASE DURING POST-PUBERTAL PERIODS IN PATIENTS WITH VESICOURETERAL REFLUX

Abstract

You have accessJournal of UrologyPediatrics: Urinary Tract Infections/Vesicoureteral Reflux1 Apr 2015MP54-01 SIGNIFICANT PREDICTORS OF CHRONIC KIDNEY DISEASE DURING POST-PUBERTAL PERIODS IN PATIENTS WITH VESICOURETERAL REFLUX Minyong Kang, Hae Won Lee, and Kwanjin Park Minyong KangMinyong Kang More articles by this author , Hae Won LeeHae Won Lee More articles by this author , and Kwanjin ParkKwanjin Park More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2024AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The paucity of evidence on renal outcomes makes it difficult to manage patients with vesicoureteral reflux (VUR) who are at risk of chronic kidney disease (CKD). Here, we examine the long-term, post-surgical clinical data of patients with VUR to evaluate the clinical features as well as significant predictors of chronic kidney disease (CKD) during post-pubertal periods. METHODS We reviewed 142 consecutive patients with VUR who were treated with either endoscopic or open surgery at our institution between September 1991 and July 2013. After exclusion of patients with incomplete data, 101 patients were included in the final analysis. CKD was defined as an estimated glomerular filtration rate (eGFR) persistently less than 60 mL/min per 1.73 m2 for at least 3 months. RESULTS The median follow-up duration was 100.0 months. The median age of patients was 16 years at the time of last follow-up. Most clinical parameters, such as body mass index, eGFR, uric acid level, and blood pressure, were significantly different between pre-operative and post-pubertal states, as these clinical parameters exhibited deterioration over time. Eleven patients (10.9%) were finally diagnosed with de novo CKD during post-pubertal periods (median time to CKD diagnosis: 104.5 months). When we examined significant predictive factors of CKD, preoperative serum blood urea nitrogen, creatinine, eGFR, and uric acid levels, as well as the presence of microalbuminuria, decreased eGFR status (< 75 mL/min per 1.73 m2), and high-grade reflux (Grades IV–V) were statistically significant in the univariate analysis. In the multivariate analysis, both serum uric acid levels (hazard ratio 2.04) and the presence of high-grade reflux (hazard ratio 11.83) were identified as significant predictors of post-pubertal CKD diagnosis. Notably, patients with high-grade reflux showed a remarkably lower probability of CKD-free survival compared to those with low-grade reflux in the Kaplan-Meier analysis. In fact, the 15-year CKD-free probability was 43.5% in patients with high-grade reflux, whereas it was 84.6 % in patients with low-grade reflux. CONCLUSIONS In conclusion, one of 10 surgically treated children with VUR eventually developed de novo CKD during post-pubertal periods. Moreover, pre-operative uric acid level and the presence of high-grade reflux were significant factors predicting post-pubertal CKD in these patients. Our results provide valuable information to expand current knowledge on kidney function changes in patients with VUR during long-term follow-up after surgery. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e664 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Minyong Kang More articles by this author Hae Won Lee More articles by this author Kwanjin Park More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...