Association between vesicoureteral reflux and renal failure among neonatally managed patients with posterior urethral valves
Yuding Wang1, Zoe Baker1, Hannah Dillon1, Andy Chang1.
1Division of Urology, Department of Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, United States
N/A.
Introduction: Posterior urethral valve (PUV) is one of the most common causes of renal failure in boys. Various predictive markers have been proposed to prognosticate clinical disease, including vesicoureteral value (VUR) status. However, previous studies have been limited by heterogeneous patient cohorts that have led to varied and sometimes conflicting results. As most diagnoses of PUV are made within the first 30 days of life, we aimed to evaluate the prognostic utility of VUR status in patients with PUV in this homogeneous population.
Methods: A single-center, retrospective review was completed of all patients with PUV diagnosed and managed within 30 days of life from 2010–2019. Previously described risk factors for renal deterioration in this population, including VUR status and nadir creatinine (Cr), were evaluated. Logistic regression analyses were used to assess the associations between VUR presence, nadir Cr, and chronic kidney disease (CKD).
Results: A total of 40 patients were identified. The mean age of diagnosis was 6.1 days (±7.3), while the mean age of valve resection was 11.2 days(±9.5). A total of 23 patients (58%) had concurrent diagnosis of VUR. The median length of followup was 48(interquartile range [IQR] 24.7–78.9) and 39 (IQR 9.5–60.5) months in the VUR and no VUR groups, respectively. The risk of developing CKD was 14.6 times greater among patients with VUR (95% confidence interval 2.5–84.8, p=0.003) compared to patients without VUR. The risk of developing a single episode of UTI within two years of diagnosis was significantly higher in the patients with VUR than those without (58.8% vs. 21.7%, p=0.02). No patients had anti-reflux surgery for VUR. Nadir Cr was significantly higher in patients with VUR (0.66 mg/dl) than in patients without VUR (0.41 mg/dl, p=0.05). No patients with a nadir Cr less than 0.8 mg/dl progressed to end-stage renal disease.
Conclusions: Using a homogeneous population, the presence of VUR in our cohort was predictive of progression to CKD, contrary to previous literature.
