ESPN 51th Annual Meeting

ESPN 2018


 
OUTCOME OF POSTERIOR URETHRAL VALVE IN 64 CHILDREN; SINGLE CENTER EXPERIENCE OF 22 YEARS
MEHTAP ÇELAKIL 1 ZELAL EKINCI 1 BURCU BOZKAYA YÜCEL 1 NAZIM MUTLU 2 AYLA GÜNLEMEZ 3 KENAN BEK 1

1- KOCAELI UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- KOCAELI UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF UROLOGY
3- KOCAELI UNIVERSITY FACULTY OF MEDICINE DEPARTMENT OF NEONATOLOGY
 
Introduction:

 Posterior urethral valve (PUV) is the most serious form of CAKUT in boys with significant risk of progression to ESRD. We present our long term results in children with PUV.

Material and methods:

Retrospective chart review of 64 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 mean age of diagnosis and follow-up time were 12,98(1day-11years) and 69,18 months (1 months-18 years) respectively. 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 3 cases (%4.7). Vesico-ureteral-reflux (VUR) was present in 31cases (%48.4).All patients had surgery and high urinary diversion was needed in 28 (43.8%). 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 7 (10.9%) were in ESRD and on dialysis. Mortality occurred in 1 (%1.5) patient. Hypertension, proteinuria and high  initial serum creatinine (>1.8mg/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 and necessity of antenatal intervention is obvious.