Risk factors for progression to end-stage renal disease in children with posterior urethral valves

ObjectiveTo identify the variables which affect long-term renal outcome in children with posterior urethral valves (PUV).Materials and methodsRetrospective analysis of 260 children with PUV who underwent ablation of valves in 1992–2008 at our tertiary care center. The following risk factors for progression to end-stage renal disease (ESRD) were analyzed: nadir serum creatinine greater than 1.0 mg/dl, bilateral grade 3 or higher VUR at diagnosis, recurrent febrile UTIs, and severe bladder dysfunction. Patients were divided into two groups: those who developed ESRD (group 1) and those who did not (group 2).ResultsForty (17.62%) patients had nadir serum creatinine >1 mg/dl. At time of initial presentation, high-grade VUR was seen in 63.1% and 33.5% of groups 1 and 2, respectively (P = 0.002). Overall, 77 (34%) of the boys developed breakthrough urinary tract infections: 37.03% and 33.5% in groups 1 and 2, respectively (P = 1). Fifty-nine (26%) patients were found to have severe bladder dysfunction: 77.8% and 19% in groups 1 and 2, respectively (P < 0.0001). Twenty-seven (11.89%) patients progressed to ESRD, at mean age of 11.21 years (5–16). On univariate analysis, the risk-predicting variables were: nadir serum creatinine value greater than 1 mg/dl (P < 0.0001), bilateral high-grade VUR (P = 0.002) and severe bladder dysfunction (P < 0.0001). On multivariate logistic regression analysis, nadir serum creatinine greater than 1 mg/dl (OR 23.79; CI 8.20–69.05) and severe bladder dysfunction (OR 5.67; CI 1.90–16.93) were found to be independent risk factors predictive of ultimate progression to ESRD.ConclusionsNadir serum creatinine and bladder dysfunction are the main factors affecting long-term renal outcome in cases of PUV. Early identification and treatment of bladder dysfunction may thus be beneficial.