Leonor Cardoso1, Patrícia Dias Santos2, Rosário Stilwell2, Claúdia Rodrigues3, Ema Santos4, Joana Patena Forte4, Pedro Morais4, Maria Costa5, Madalena Borges5, Rute Baeta Baptista5,6, Telma Francisco5,6, Gisela Neto5, Sofia Lima4, Aline Vaz Silva4, Vanda Pratas Vital4, Dinorah Cardoso4, Fátima Alves4, Margarida Abranches5.
1Department of Paediatrics, Unidade Local de Saúde da Cova da Beira, Covilhã, Portugal,
2Department of Paediatrics, Hospital Dona Estefânia, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal,
3Department of Paediatrics, Unidade Local de Saúde Médio Tejo, Torres Novas, Portugal,
4Paediatric Urology Unit, Hospital Dona Estefânia, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal,
5Paediatric Nephrology Unit, Hospital Dona Estefânia, Unidade Local de Saúde São José, Centro Clínico Académico de Lisboa, Lisboa, Portugal,
6NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade Nova de Lisboa, Centro Clínico Académico de Lisboa, Lisboa, Portugal.
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Abstract
Background: Posterior urethral valves (PUV) affect 1 in 5,000 live male births, with 8–21% progressing to end-stage kidney disease (ESKD) within ten years. Early predictors of adverse kidney outcomes in PUV are poorly defined.
Methods: A retrospective cohort study was conducted on children who underwent PUV ablation at a single center from January 2015 to June 2022. Patients with less than six months of follow-up were excluded. The primary outcome was a composite of low estimated glomerular filtration rate (eGFR) for age or the need for kidney replacement therapy (KRT).
Results: Among 41 patients, 24 (59%) were diagnosed prenatally, and 14 (34%) were referred from other countries. Prenatally diagnosed patients were more likely to be born preterm (50% vs. 12%, p = 0.006) and had higher baseline serum creatinine (0.66 [IQR 0.49-2.45] vs. 0.52 [IQR 0.44-0.54] mg/dL; p = 0.036). Over a median follow-up of 3.1 years, 13 patients (32%) met the primary outcome, including three requiring peritoneal dialysis, all born preterm. Logistic regression analyses, adjusted for age at last follow-up, identified prenatal diagnosis (OR 7.49; 95% CI 1.18-47.56; p = 0.033), prematurity (OR 18.59; 95% CI 2.63-131.50; p = 0.003), and high pre-ablation serum creatinine (OR 5.88; 95% CI 1.19-28.97; p = 0.029) as significant predictors of adverse outcomes.
Conclusion: Nearly one-third of the cohort experienced a decline in eGFR or required KRT. Prenatal diagnosis, prematurity, and elevated pre-ablation serum creatinine were significant predictors of adverse kidney outcomes in children with PUV.
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