Pediatric Nephro-Urology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London SE1 7EH, UK.
Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy.
Int J Environ Res Public Health. 2023 Jun 27;20(13):6238. doi: 10.3390/ijerph20136238.
The presence of unilateral vesicoureteral reflux (VUR), and renal dysplasia associated with posterior urethral valves (PUV) (VURD syndrome) was believed to represent a pressure-released pop-off mechanism protecting kidney function. We aimed to investigate its role with respect to long-term kidney function in a cross-sectional and longitudinal analysis. We compared the iohexol glomerular filtration rate (GFR) measured at 5 (GFR) and 10 (GFR) years of age in children with (Group A) and without (Group B) VURD syndrome, who underwent PUV resection under 2 years of age. VURD syndrome was diagnosed in cases of unilateral loss of kidney function (<15% on nuclear medicine test) associated with ipsilateral grade IV-V VUR. VURD syndrome was diagnosed in 16 (12.8%) out of 125 patients who met the inclusion criteria. While the median GFR was similar in the 2 groups [Group A: 87.3 (74.7-101.2) mL/min/1.73 m vs. Group B: 99.6 (77-113) mL/min/1.73 m, -value: 0.181], the median GFR values were significantly lower in children with VURD syndrome [Group A: 75.7 (71.2-85.9) mL/min/1.73 m vs. Group B: 95.1 (81.2-114.2) mL/min/1.73 m, -value: 0.009]. Similar results were obtained in a longitudinal analysis of the children with GFR measurement available both at 5 and 10 years of age [GFR in Group A: 93.1 (76.9-103.5) mL/min/1.73 m vs. Group B: 97.5 (80-113) mL/min/1.73 m, -value: 0.460; GFR: Group A: 71.9 (71.9-85.9) mL/min/1.73 m vs. Group B: 94.8 (81.5-110.6) mL/min/1.73 m, -value: 0.024]. In conclusion, VURD syndrome does not show a protective role in kidney function preservation. On the contrary, it seems to be associated with a deterioration of the kidney function on a long-term follow-up.
单侧输尿管反流（VUR）和后尿道瓣膜（PUV）相关的肾发育不良（VURD 综合征）被认为代表了一种保护肾功能的压力释放式溢流机制。我们旨在通过横断面和纵向分析来研究其与长期肾功能的关系。我们比较了 2 岁以下接受 PUV 切除的患儿中存在（A 组）和不存在（B 组）VURD 综合征的患儿在 5 岁（GFR）和 10 岁（GFR）时的碘海醇肾小球滤过率（GFR）。单侧肾功能丧失（核医学检查<15%）伴同侧 IV-V 级 VUR 时诊断为 VURD 综合征。125 例符合纳入标准的患者中，16 例（12.8%）诊断为 VURD 综合征。2 组的中位 GFR 相似[A 组：87.3（74.7-101.2）mL/min/1.73 m 与 B 组：99.6（77-113）mL/min/1.73 m，-值：0.181]，但 VURD 综合征患儿的中位 GFR 值明显较低[A 组：75.7（71.2-85.9）mL/min/1.73 m 与 B 组：95.1（81.2-114.2）mL/min/1.73 m，-值：0.009]。在对 5 岁和 10 岁时均有 GFR 测量值的患儿进行的纵向分析中也得到了类似的结果[GFR A 组：93.1（76.9-103.5）mL/min/1.73 m 与 B 组：97.5（80-113）mL/min/1.73 m，-值：0.460；GFR：A 组：71.9（71.9-85.9）mL/min/1.73 m 与 B 组：94.8（81.5-110.6）mL/min/1.73 m，-值：0.024]。总之，VURD 综合征在保护肾功能方面没有表现出保护作用。相反，它似乎与长期随访中肾功能的恶化有关。
