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Predicting childhood chronic kidney disease severity in infants with posterior urethral valve: a critical analysis of creatinine values in the first year of life

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Abstract

Background

Posterior urethral valve (PUV) is a leading cause of chronic kidney failure in children. Studies have shown that a creatinine nadir above historical cutoff values of 0.8 or 1.0 mg/dL correlates with worse kidney outcomes. The ability to use nadir creatinine more discriminately as a test of kidney outcomes is otherwise limited.

Methods

We performed a retrospective review of 102 infants treated with primary valve ablation prior to 1 year of age. Patient factors including creatinine at presentation (Cr-P), nadir within 6 weeks after ablation (Cr-6 W), and nadir within 1 year after ablation (Cr-1Y) were assessed as predictors of final chronic kidney disease (CKD) severity. An optimal threshold for four CKD levels was defined in incremental fashion using binary outcome with receiver operating characteristic (ROC). Multivariable logistic regression models compared Cr-P, Cr-6 W, and Cr-1Y while adjusting for patient factors.

Results

Boys were ablated at mean age of 36.3 days and followed for 6.6 years (± 3.7). When compared to other demographics, only creatinine remained independently predictive of CKD outcomes on multivariable analysis. ROC analysis demonstrated excellent diagnostic accuracy for Cr-6 W and Cr-1Y (p < 0.001) and acceptable accuracy for Cr-P (p < 0.005). Using the Cr-6 W and Cr-1Y models, high sensitivity and specificity creatinine nadir cutoffs were determined to predict each CKD outcome.

Conclusions

The severity of childhood CKD can be predicted with high accuracy using the creatinine nadir within 6 weeks of ablation. The cutoff values described can be incorporated into a clinical setting for patient counseling and individual risk stratification.

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References

  1. Brownlee E, Wragg R, Robb A, Chandran H, Knight M, McCarthy L, BAPS-CASS (2019) Current epidemiology and antenatal presentation of posterior urethral valves: outcome of BAPS CASS National Audit. J Pediatr Surg 54:318–321

    Article  Google Scholar 

  2. Caione P, Nappo SG (2011) Posterior urethral valves: long-term outcome. Pediatr Surg Int 27:1027–1035

    Article  Google Scholar 

  3. Coleman R, King T, Nicoara CD, Bader M, McCarthy L, Chandran H, Parashar K (2015) Nadir creatinine in posterior urethral valves: how high is low enough? J Pediatr Urol 11(356):e351-355

    Google Scholar 

  4. Sarhan OM, El-Ghoneimi AA, Helmy TE, Dawaba MS, Ghali AM, el Ibrahiem HI (2011) Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol 185:2491–2495

    Article  Google Scholar 

  5. Bilgutay AN, Roth DR, Gonzales ET Jr, Janzen N, Zhang W, Koh CJ, Gargollo P, Seth A (2016) Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol 12(179):e171-177

    Google Scholar 

  6. Coquillette M, Lee RS, Pagni SE, Cataltepe S, Stein DR (2020) Renal outcomes of neonates with early presentation of posterior urethral valves: a 10-year single center experience. J Perinatol 40:112–117

    Article  Google Scholar 

  7. Warshaw BL, Hymes LC, Trulock TS, Woodard JR (1985) Prognostic features in infants with obstructive uropathy due to posterior urethral valves. J Urol 133:240–243

    Article  CAS  Google Scholar 

  8. DeFoor W, Clark C, Jackson E, Reddy P, Minevich E, Sheldon C (2008) Risk factors for end stage renal disease in children with posterior urethral valves. J Urol 180:1705–1708; discussion 1708

  9. Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637

    Article  Google Scholar 

  10. Ansari MS, Gulia A, Srivastava A, Kapoor R (2010) Risk factors for progression to end-stage renal disease in children with posterior urethral valves. J Pediatr Urol 6:261–264

    Article  CAS  Google Scholar 

  11. Kousidis G, Thomas DF, Morgan H, Haider N, Subramaniam R, Feather S (2008) The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23-year follow-up study. BJU Int 102:1020–1024

    Article  Google Scholar 

  12. Hennus PM, van der Heijden GJ, Bosch JL, de Jong TP, de Kort LM (2012) A systematic review on renal and bladder dysfunction after endoscopic treatment of infravesical obstruction in boys. PLoS One 7:e44663

    Article  CAS  Google Scholar 

  13. Duckett JW (1983) Management of posterior urethral valves. AUA Weekly Update Series 2

  14. Hulbert WC, Duckett JW (1988) Current views on posterior urethral valves. Pediatr Ann 17:31–36

    Article  CAS  Google Scholar 

  15. Rittenberg MH, Hulbert WC, Snyder HM 3rd, Duckett JW (1988) Protective factors in posterior urethral valves. J Urol 140:993–996

    Article  CAS  Google Scholar 

  16. Lopez Pereira P, Espinosa L, Martinez Urrutina MJ, Lobato R, Navarro M, Jaureguizar E (2003) Posterior urethral valves: prognostic factors. BJU Int 91:687–690

    Article  CAS  Google Scholar 

  17. Pohl M, Mentzel HJ, Vogt S, Walther M, Ronnefarth G, John U (2012) Risk factors for renal insufficiency in children with urethral valves. Pediatr Nephrol 27:443–450

    Article  Google Scholar 

  18. Denes ED, Barthold JS, Gonzalez R (1997) Early prognostic value of serum creatinine levels in children with posterior urethral valves. J Urol 157:1441–1443

    Article  CAS  Google Scholar 

  19. Demirkan H, Yesildal C (2020) Serum creatinine levels in cases of posterior urethral valve: 29 years experience of a pediatric urology reference center. Low Urin Tract Symptoms 12:274–277

    Article  CAS  Google Scholar 

  20. Vasconcelos MA, Silva ACSE, Gomes IR, Carvalho RA, Pinheiro SV, Colosimo EA, Yorgin P, Mak RH, Oliveira EA (2019) A clinical predictive model of chronic kidney disease in children with posterior urethral valves. Pediatr Nephrol 34:283–294

    Article  Google Scholar 

  21. Onuora VC, Mirza K, Koko AH, Al Turki M, Meabed AH, Al Jawini N (2000) Prognostic factors in Saudi children with posterior urethral valves. Pediatr Nephrol 14:221–223

    Article  CAS  Google Scholar 

  22. Deshpande AV, Alsaywid BS, Smith GH (2011) Setting the speed limit: a pilot study of the rate of serum creatinine decrease after endoscopic valve ablation in neonates. J Urol 185:2497–2500

    Article  CAS  Google Scholar 

  23. Churchill BM, Khoury AE, McLorie GA (1989) Posterior urethral valves. Acta Urol Belg 57:435–449

    CAS  PubMed  Google Scholar 

  24. Sarhan O, El-Dahshan K, Sarhan M (2010) Prognostic value of serum creatinine levels in children with posterior urethral valves treated by primary valve ablation. J Pediatr Urol 6:11–14

    Article  Google Scholar 

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Authors and Affiliations

  1. Division of Pediatric Urology, Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Charlotte Q. Wu

  2. Division of Pediatric Urology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, 30328, USA

    Emily S. Blum & Edwin A. Smith

  3. Department of Urology, Emory University School of Medicine, Atlanta, GA, USA

    Dattatraya Patil

  4. Division of Pediatric Nephrology, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA

    H. Stella Shin

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  1. Charlotte Q. Wu
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  2. Emily S. Blum
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  3. Dattatraya Patil
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  4. H. Stella Shin
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  5. Edwin A. Smith
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Correspondence to Edwin A. Smith.

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Wu, C.Q., Blum, E.S., Patil, D. et al. Predicting childhood chronic kidney disease severity in infants with posterior urethral valve: a critical analysis of creatinine values in the first year of life. Pediatr Nephrol 37, 1339–1345 (2022). https://doi.org/10.1007/s00467-021-05271-w

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  • DOI: https://doi.org/10.1007/s00467-021-05271-w

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