Denes E D, Barthold J S, González R
Department of Pediatric Urology, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, USA.
J Urol. 1997 Apr;157(4):1441-3.
We evaluated the prognostic value of serum creatinine level at initial treatment for future renal function in children with posterior urethral valves.
We reviewed the records of 35 patients with posterior urethral valves presenting in the first year of life and treated initially at our institution between 1973 and 1990 with valve ablation or vesicostomy. Initial assessment included serum creatinine determination, urine culture, renal ultrasonography and voiding cystourethrography. After 4 or 5 days of catheter bladder drainage renal ultrasound and serum creatinine measurement were repeated. At the end of followup patients were divided into 2 groups according to glomerular filtration rate calculated by the Schwartz formula: group 1--69 ml. or less per minute per 1.73 m.2 (median 15) and group 2--greater than 70 ml. per minute per 1.73 m.2 (median 110). Median followup was 102 months (8.5 years, range 50 to 219 months).
Mean serum creatinine at diagnosis plus or minus standard deviation was 3.60 +/- 2.01 and 1.3 +/- 0.7 mg./dl. in groups 1 and 2, respectively (normal 0.1 to 0.6, p < 0.01). Mean serum creatinine after catheterization was 2.4 +/- 1.1 and 0.6 +/- 0.2 mg./dl. in groups 1 and 2, respectively (p < 0.01). Mean nadir creatinine during the first year of life was 1.7 +/- 0.6 and 0.4 +/- 0.2 mg./dl. in groups 1 and 2, respectively (p < 0.01). All differences were statistically significant. Linear regression analysis of creatinine after catheterization and glomerular filtration rate at last followup demonstrated a correlation coefficient of -0.7 (p < 0.01).
Although it is well known that nadir creatinine in the first year of life correlates with prognosis, the correlation of long-term renal function with creatinine at valve ablation or vesicostomy is more useful to the clinician. These data indicate that serum creatinine level 4 to 5 days after the initial diagnosis correlates strongly with long-term renal function in children with posterior urethral valves.
我们评估了后尿道瓣膜症患儿初始治疗时血清肌酐水平对其未来肾功能的预后价值。
我们回顾了1973年至1990年间在我院接受治疗的35例1岁内后尿道瓣膜症患儿的记录，这些患儿最初接受了瓣膜切除术或膀胱造瘘术。初始评估包括血清肌酐测定、尿培养、肾脏超声检查和排尿性膀胱尿道造影。导尿管膀胱引流4或5天后，重复进行肾脏超声检查和血清肌酐测量。随访结束时，根据施瓦茨公式计算的肾小球滤过率将患者分为两组：第1组——每分钟每1.73平方米69毫升或更低（中位数15），第2组——每分钟每1.73平方米大于70毫升（中位数110）。中位随访时间为102个月（8.5年，范围50至219个月）。
第1组和第2组诊断时的平均血清肌酐（标准差）分别为3.60±2.01和1.3±0.7毫克/分升（正常范围0.1至0.6，p<0.01）。导尿后的平均血清肌酐在第1组和第2组分别为2.4±1.1和0.6±0.2毫克/分升（p<0.01）。第1年生命中的平均最低肌酐在第1组和第2组分别为1.7±0.6和0.4±0.2毫克/分升（p<0.01）。所有差异均具有统计学意义。导尿后肌酐与最后随访时肾小球滤过率的线性回归分析显示相关系数为-0.7（p<0.01）。
虽然众所周知1岁内的最低肌酐与预后相关，但瓣膜切除术或膀胱造瘘术时肌酐与长期肾功能的相关性对临床医生更有用。这些数据表明，初始诊断后4至5天的血清肌酐水平与后尿道瓣膜症患儿的长期肾功能密切相关。
