1 - Paediatric Nephrology Unit, Department of Paediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
2 - Department of Paediatrics, Centro Hospitalar Médio Tejo, Portugal
3 - Department of Paediatrics, Hospital do Espírito Santo, Évora, Portugal
4 - Paediatric Urology Unit, Department of Paediatric Surgery, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
- VII Congresso Hispano-Português de Nefrologia Pediátrica e XLVI Congreso Español de Nefrologia Pediátrica. 18 e 19 de Maio de 2023, NOVA Medical School, Lisboa. Comunicação oral longa.
Introduction: Posterior urethral valves (PUV) affect approximately 1:5000 live male births, with about 50% progressing to end-stage renal disease within ten years.
Objectives: We aimed to identify predictors of kidney outcomes for children diagnosed with PUV.
Methods: This retrospective single-center cohort study included children who underwent a PUV ablation between 1st January 2015 and 30th June 2022. Patients with less than six months of follow-up were excluded. The primary outcome was a composite of glomerular filtration rate (GFR) below -2 SD of expected for age or renal replacement therapy therapy (RRT).
Results: From a total of 41 patients in the cohort, 22 (54%) were diagnosed prenatally and 12 (29%) were referred to us from Portuguese-speaking African countries. Patients with a prenatal diagnosis were more frequently born preterm (54.5% versus 11.8%, p-value=0.006), were younger at first urethral catheter placement (7.8±15.1 days versus 1.1±2.5 years, p-value=0.07), and had higher baseline serum creatinine (1.5±1.5 versus 0.6±0.2 mg/dL, p-value=0.036) than patients diagnosed postnatally. There were no other significant differences in between-groups comparisons at baseline. Mean follow-up time was 3.1±1.4 years. At last follow-up, median age was 2.6 years [interquartile range (IQR) 0.9-3.9] and median GFR was 95.4 mL/min/1.73m2 [IQR 79.2-115.1]. Thirteen patients (31.7%) met the primary outcome. Three patients (7.3%) needed peritoneal dialysis and another 13 (31.7%) had a low GFR for age. In the logistic regression analyses adjusted for age at last follow-up, prenatal diagnosis (OR 8.1, 95% CI 1.3-50.7, p=0.025), prematurity (OR 2.8, 95% CI 1.3-6.3, p=0.012), and higher serum creatinine at baseline (OR 5.7, 95% CI 1.2-27.5, p=0.030) were significant predictors of the primary outcome.
Conclusion: Prenatal diagnosis of PUV, prematurity and higher serum creatinine before VUP ablation may predict adverse kidney outcomes (low GFR and RRT). Our sample size and time of follow-up may have limited our conclusions.
Palavras Chave: children, chronic kidney disease, Posterior urethral valves