Long-Term Risk of End Stage Renal Disease in Patients With Posterior Urethral Valves
Congenital obstructive uropathy can lead to end stage renal disease. Progression to end stage renal disease in childhood is well described but long-term prognosis in adulthood has not been thoroughly investigated. In this study we evaluated the risk of end stage renal disease in patients with posterior urethral valves.
Materials and Methods:
During 1953 to 2003 a total of 200 male patients were treated for posterior urethral valves at our institution and of these 193 could be followed for renal outcome. Followup data on patients treated with dialysis or kidney transplantation were collected from patient records and the Finnish Kidney Transplantation Registry, and data on deceased patients were collected from hospital records and the Finnish Population Register Centre.
Median patient age at evaluation was 31 years (range 6 to 69). Of the 193 patients followed 44 (22.8%) had progression to end stage renal disease. According to a Kaplan-Meier analysis the lifetime risk of end stage renal disease was 28.5% (SE 3.8%). No patient had end stage renal disease after the age of 34 years. The lowest serum creatinine value during postoperative year 1 was associated with speed of progression to end stage renal disease. Early presentation, pneumothorax, bilateral vesicoureteral reflux and recurrent urinary tract infections after the abolition of urethral obstruction were associated with an increased risk of end stage renal disease at followup.
Congenital obstructive uropathy can lead to end stage renal disease during childhood or young adulthood. However, the risk of end stage renal disease seems to decrease eventually. Poor kidney function at presentation is associated with worse renal prognosis.
- 1 : Posterior urethral valves. Br J Urol1996; 78: 275. Google Scholar
- 2 : Posterior urethral valves. ScientificWorldJournal2009; 9: 1119. Google Scholar
- 3 : Contributions of the Transplant Registry: The 2006 Annual Report of the North American Pediatric Renal Trials and Collaborative Studies (NAPRTCS). Pediatr Transplant2007; 11: 366. Google Scholar
- 4 : Current trends in the management of posterior urethral valves in the pediatric population. Urology2002; 60: 947. Google Scholar
- 5 : Obstructive nephropathy in children: long-term progression after relief of posterior urethral valve. Pediatrics2001; 107: 1004. Google Scholar
- 6 : Long-term outcome of boys with posterior urethral valves. Br J Urol1988; 62: 59. Crossref, Medline, Google Scholar
- 7 : Boys with posterior urethral valves: outcome concerning renal function, bladder function and paternity at ages 31 to 44 years. J Urol2005; 174: 1031. Link, Google Scholar
- 8 : The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol1996; 155: 1730. Link, Google Scholar
- 9 : The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23-year follow-up study. BJU Int2008; 102: 1020. Google Scholar
- 10 : Prenatal diagnosis: what do we know of long-term outcomes?. J Pediatr Urol2010; 6: 204. Google Scholar
- 11 : Prognosis for patients with prenatally diagnosed posterior urethral valves. J Urol1992; 148: 125. Link, Google Scholar
- 12 : Posterior urethral valves: Does prenatal diagnosis influence prognosis?. Br J Urol1993; 72: 830. Google Scholar
- 13 : Early prognostic value of serum creatinine levels in children with posterior urethral valves. J Urol1997; 157: 1441. Link, Google Scholar
- 14 : Progression to end-stage renal disease in children with posterior urethral valves. Pediatr Nephrol1998; 12: 630. Google Scholar
- 15 : Prognostic factors in prenatally-detected posterior urethral valves: a multivariate analysis. Pediatr Surg Int2002; 18: 662. Google Scholar
- 16 : Risk factors for end stage renal disease in children with posterior urethral valves. J Urol2008; 180: 1705. Link, Google Scholar
- 17 : Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol2004; 171: 2409. Link, Google Scholar
- 18 : Vesicoureteral reflux in conjunction with posterior urethral valves. J Urol2009; 182: 1555. Link, Google Scholar
- 19 : Perinatal rupture of the uropoietic system. Clin Nephrol2002; 57: 432. Google Scholar
- 20 : Urinomas protect renal function in posterior urethral valves–a population based study. J Pediatr Surg2010; 45: 407. Google Scholar
- 21 : Management of urinary extravasation in 18 boys with posterior urethral valves. J Urol2003; 169: 1508. Link, Google Scholar
- 22 : Impact of prenatal urinomas in patients with posterior urethral valves and postnatal renal function. J Perinat Med2006; 34: 425. Google Scholar
- 23 : The valve bladder syndrome: 20 years later. J Urol2001; 166: 1406. Link, Google Scholar
- 24 : Bladder dysfunction as a prognostic factor in patients with posterior urethral valves. BJU Int2002; 90: 308. Google Scholar
- 25 : Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation. J Urol2008; 179: 307. Link, Google Scholar