Posterior urethral valves: Risk factors for progression to renal failure

Our finding that creatinine is the only independent risk factor for poor renal outcomes in PUV patients is consistent with the literature. The effect of VUR has been controversial, and our finding that VUR is associated with need for multiple surgeries but not with CKD or ESRD is novel. Limitations include biases inherent to retrospective studies and relatively small sample size. The majority of patients with PUVs (56.7%) required one surgery and maintained renal function with CKD II or better (79.8%) up to 2 years after initial surgery. While multiple factors were associated with poor renal outcomes, nadir creatinine was the only independent predictor. VUR and recurrent UTIs were not associated with poor renal outcomes. Longer follow-up is necessary to identify risk factors for delayed progression of renal disease.Table. Summary of results.A. Predictors of ESRDp-valueCategoricalPrematurity0.010Prenatal diagnosis0.034Abnormal renal cortex on initial RUS0.011Loss of CMD on initial RUS<0.001ContinuousPresenting creatinine: mean non-ESRD pts vs ESRD pts: 1.3 vs 2.9<0.001Nadir creatinine: mean non-ESRD pts vs ESRD pts: 0.4 vs 2.7<0.0001B. Predictors of CKDp-valueCategoricalPrematurity0.038Prenatal diagnosis0.014Abnormal renal cortex on initial RUS<0.001Loss of CMD on initial RUS<0.001ContinuousPresenting creatinine: mean non-ESRD pts vs ESRD pts: 1.3 vs 2.9<0.0001Nadir creatinine: mean non-ESRD pts vs ESRD pts: 0.4 vs 2.7<0.0001C. Predictors of >1 surgeryp-valueCategoricalPrematurity0.028Prenatal diagnosis0.027Symptomatic presentation0.048Recurrent UTIs<0.001Pre-op VUR0.006Post-op VUR0.049Loss of CMD<0.001CKD, chronic kidney disease; CMD, corticomedullary differentiation; ESRD, end-stage renal disease; RUS, renal ultrasound; UTIs, urinary tract infections; VUR, vesicoureteral reflux.