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Risk factors for renal insufficiency in children with urethral valves

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Abstract

Posterior urethral valves (PUV) associated with renal dysplasia are one of the most common causes of end stage kidney disease (ESKD) in childhood. In order to identify risk factors for the progression of this condition to early renal failure, we have retrospectively analyzed the clinical course, renal function, and first postnatal renal ultrasound in a sample of 42 young male patients with PUV, who were followed at a single center. Twelve (28.6%) were diagnosed with ESKD at a median age of 11.3 years. Our comparison of PUV patients without decreased estimated glomerular filtration rate (eGFR) (group A; K/DOQI CKD stage 0–1) with PUV patients showing a decreased eGFR (group B; K/DOQI CKD stage 2–5) revealed the following significant risk factors for loss of eGFR: renal volume <3rd percentile (P < 0.001), elevated echogenicity (P = 0.001), pathologic corticomedullary differentiation (P < 0.001), >3 febrile urinary tract infections (P = 0.012), and decreased eGFR at 1 year of age (P < 0.001). Receiver operating characteristic curve analysis in the cohort confirms that patients showing a renal volume >88.2 ml/m2 body surface area (BSA) are not at risk to develop K/DOQI CKD stage 5 (sensitivity 75%, specificity 77.3%, positive/negative predictive value 37.5/94.4%). Ultrasound promises to be a valuable tool for identifying endangered patients.

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Abbreviations

K/DOQI:

Kidney Disease Outcomes Quality Initiative

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Children’s Hospital, Friedrich Schiller University, Jena, Germany

    Michael Pohl, Gabriele Rönnefarth & Ulrike John

  2. Department of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology I, Friedrich Schiller University, Jena, Germany

    Hans-Joachim Mentzel & Susanna Vogt

  3. Institute of Medical Statistics, Computer Sciences and Documentation, Friedrich Schiller University, Jena, Germany

    Mario Walther

Authors
  1. Michael Pohl
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  2. Hans-Joachim Mentzel
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  3. Susanna Vogt
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  4. Mario Walther
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  5. Gabriele Rönnefarth
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  6. Ulrike John
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Correspondence to Michael Pohl.

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Pohl, M., Mentzel, HJ., Vogt, S. et al. Risk factors for renal insufficiency in children with urethral valves. Pediatr Nephrol 27, 443–450 (2012). https://doi.org/10.1007/s00467-011-1999-2

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  • DOI: https://doi.org/10.1007/s00467-011-1999-2

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