后尿道瓣膜症患儿的长期肾脏转归：一项基于人群的队列研究
Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study.
作者信息
Robinson Cal H, Rickard Mandy, Jeyakumar Nivethika, Smith Graham, Richter Juliane, Van Mieghem Tim, Dos Santos Joana, Chanchlani Rahul, Lorenzo Armando J
机构信息
Division of Nephrology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.
Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.
出版信息
J Am Soc Nephrol. 2024 Dec 1;35(12):1715-1725. doi: 10.1681/ASN.0000000000000468. Epub 2024 Aug 21.
KEY POINTS
Among 727 children with posterior urethral valves, 32% had major adverse kidney events (death, kidney failure, or CKD) over a median of 14.2-year follow-up. Children with posterior urethral valves were at substantially higher risks of kidney failure, CKD, and hypertension than the general population. This justifies close kidney health surveillance among children with posterior urethral valves and optimized transitions to adult urologic care.
BACKGROUND
Posterior urethral valves represent the most common cause of lower urinary tract obstruction in male infants (approximately 1/4000 live births). Long-term kidney outcomes of posterior urethral valves remain uncertain. We aimed to determine the time-varying risk of major adverse kidney events (MAKE) following children with posterior urethral valves into adulthood.
METHODS
A population-based retrospective cohort study of all male children (<2 years) diagnosed with posterior urethral valves between 1991 and 2021 in Ontario, Canada. Comparator cohorts were () male general population and () male children with pyeloplasty (both <2 years). The primary outcome was MAKE (death, long-term KRT [dialysis or kidney transplant], or CKD). Time to MAKE was analyzed using multivariable-adjusted Cox proportional hazards models. We censored for provincial emigration or administrative censoring (March 31, 2022).
RESULTS
We included 727 children with posterior urethral valves, 855 pyeloplasty comparators, and 1,013,052 general population comparators. The median follow-up time was 16.6 years (Q1–3, 8.6–24.5) overall. Throughout follow-up, 32% of children with posterior urethral valves developed MAKE versus 1% of the general population and 6% of pyeloplasty comparators. Their adjusted hazard ratio for MAKE was 36.6 (95% confidence interval, 31.6 to 42.4) versus the general population. The risk of developing MAKE declined over the first 5 years after posterior urethral valve diagnosis but remained elevated for >30-year follow-up. Children with posterior urethral valves were also at higher risk of death, CKD, long-term KRT, hypertension, and AKI than the general population or pyeloplasty comparators.
CONCLUSIONS
Children with posterior urethral valves are at higher risk of adverse long-term kidney outcomes well into adulthood.
要点
在727例后尿道瓣膜患儿中，经过中位14.2年的随访，32%发生了严重不良肾脏事件（死亡、肾衰竭或慢性肾脏病）。后尿道瓣膜患儿发生肾衰竭、慢性肾脏病和高血压的风险显著高于普通人群。这证明了对后尿道瓣膜患儿进行密切的肾脏健康监测以及优化向成人泌尿外科护理过渡的合理性。
背景
后尿道瓣膜是男婴下尿路梗阻最常见的原因（约为1/4000活产儿）。后尿道瓣膜的长期肾脏转归仍不确定。我们旨在确定后尿道瓣膜患儿成年后严重不良肾脏事件（MAKE）随时间变化的风险。
方法
对1991年至2021年在加拿大安大略省诊断为后尿道瓣膜的所有男童（<2岁）进行基于人群的回顾性队列研究。对照队列分别为（）男性普通人群和（）接受肾盂成形术的男童（均<2岁）。主要结局是MAKE（死亡、长期肾脏替代治疗[透析或肾移植]或慢性肾脏病）。使用多变量调整的Cox比例风险模型分析发生MAKE的时间。我们对省级移民或行政审查（2022年3月31日）进行了截尾。
结果
我们纳入了727例后尿道瓣膜患儿、855例肾盂成形术对照者和1,013,052例普通人群对照者。总体中位随访时间为16.6年（四分位间距，8.6 - 24.5年）。在整个随访期间，32%的后尿道瓣膜患儿发生MAKE，而普通人群为1%，肾盂成形术对照者为6%。与普通人群相比，他们发生MAKE的调整后风险比为36.6（95%置信区间，31.6至42.4）。后尿道瓣膜诊断后的前5年发生MAKE的风险下降，但在超过30年的随访中仍居高不下。后尿道瓣膜患儿死亡、慢性肾脏病、长期肾脏替代治疗、高血压和急性肾损伤的风险也高于普通人群或肾盂成形术对照者。
结论
后尿道瓣膜患儿成年后发生不良长期肾脏转归的风险更高。
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