ORIGINAL ARTICLE   Free access

Minerva Urologica e Nefrologica 2019 December;71(6):651-6

DOI: 10.23736/S0393-2249.19.03272-7

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Outcome of posterior urethral valve in 64 children: a single center’s 22-year experience

Mehtap EZEL ÇELAKIL ¹ ✉, Zelal EKİNCİ ¹, Burcu BOZKAYA YÜCEL ¹, Nazım MUTLU ², Ayla GÜNLEMEZ ³, Kenan BEK ¹

¹ Department of Pediatric Nephrology, Faculty of Medicine, Kocaeli University, İzmit, Turkey; ² Department of Urology, Faculty of Medicine, Kocaeli University, İzmit, Turkey; ³ Department of Neonatology, Faculty of Medicine, Kocaeli University, İzmit, Turkey

BACKGROUND: Posterior urethral valve (PUV) is the most serious form of congenital anomalies of kidney and urinary tract (CAKUT) in boys with significant risk of progression to chronic kidney disease (CKD). We present our long-term results in children with PUV.
METHODS: Retrospective chart review of 113 children with PUV followed within the years of 1996-2018 was performed. Clinical, laboratory and epidemiologic parameters were analyzed for their impact on renal outcome.
RESULTS: The median age of diagnosis was 1.00 month (1.00-132.00) and the median follow-up period was 70 months (60.00-216.00). Antenatal diagnosis was present in 33 patients (51.5%) mainly with bilateral hydronephrosis and oligohydramnios. The most common postnatal presentation was recurrent urinary tract infection (UTI) in 14 cases (21.9%) and incontinence in three cases (4.7%). Vesicoureteral-reflux (VUR) was present in 31 cases (48.4%). All patients had surgery and urinary diversion was needed in 18 (28.2%). Varying stages of chronic kidney disease (CKD) developed in 23 cases (35.9%) and rise in serum creatinine was especially prominent after the 4th year of follow-up. Of 23 CKD patients, seven (10.9%) were in ESRD and on dialysis. Mortality occurred in one (1.5%) patient. Hypertension, proteinuria and high initial serum creatinine (>1.28 mg/dL) were statistically significant risk factors for CKD, as expected. Surprisingly VUR and UTI did not show such a significant impact on CKD development. Antenatal detection was with significantly less risk for CKD.
CONCLUSIONS: Our results confirm that PUV has a considerable risk for CKD development. Antenatal diagnosis, management of proteinuria and hypertension may modify this progression. But already injured kidneys still have a potential risk. The need for further research to evaluate the impact of any intervention on long term renal outcome is obvious.

KEY WORDS: Urethra; Congenital abnormalities; Chronic renal insufficiency; Child