Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raibreli Road, Lucknow-U.P. 226014, India.
J Pediatr Urol. 2010 Jun;6(3):261-4. doi: 10.1016/j.jpurol.2009.09.001. Epub 2009 Oct 14.
To identify the variables which affect long-term renal outcome in children with posterior urethral valves (PUV).
Retrospective 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 1.0mg/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).
Forty (17.62%) patients had nadir serum creatinine >1mg/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 1mg/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 1mg/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.
Nadir 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.
确定影响后尿道瓣膜（PUV）患儿长期肾脏结局的变量。
对 1992 年至 2008 年在我们的三级医疗中心接受瓣膜消融术的 260 名 PUV 患儿进行回顾性分析。分析了以下进展为终末期肾病（ESRD）的危险因素：血清肌酐最低值>1.0mg/dl、诊断时双侧 3 级或更高级别的反流（VUR）、复发性发热性尿路感染和严重膀胱功能障碍。将患者分为两组：发展为 ESRD（组 1）和未发展为 ESRD（组 2）。
40 名（17.62%）患者血清肌酐最低值>1mg/dl。在初次就诊时，组 1 和组 2 的高分级 VUR 分别为 63.1%和 33.5%（P=0.002）。总体而言，77 名（34%）男孩发生了突破性尿路感染：组 1 和组 2 分别为 37.03%和 33.5%（P=1）。59 名（26%）患者发现严重膀胱功能障碍：组 1 和组 2 分别为 77.8%和 19%（P<0.0001）。27 名（11.89%）患者进展为 ESRD，平均年龄为 11.21 岁（5-16 岁）。单因素分析发现，有预测风险的变量为：血清肌酐最低值>1mg/dl（P<0.0001）、双侧高分级 VUR（P=0.002）和严重膀胱功能障碍（P<0.0001）。多因素 logistic 回归分析发现，血清肌酐最低值>1mg/dl（OR 23.79；CI 8.20-69.05）和严重膀胱功能障碍（OR 5.67；CI 1.90-16.93）是最终进展为 ESRD 的独立危险因素。
血清肌酐最低值和膀胱功能障碍是 PUV 患儿长期肾脏结局的主要影响因素。早期识别和治疗膀胱功能障碍可能有益。
