Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients,Pediatric Nephrology

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Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2023-09-02 , DOI: 10.1007/s00467-023-06128-0
Victoria W Huang ₁ , Mohga Behairy ₂ , Benjamin Abelson ₃ , Alice Crane ₃ , Wei Liu ₄ , Lu Wang ₄ , Katherine M Dell _{1,

2,

5} , Audrey Rhee _{1,

3}

Affiliation

Background

Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors.

Methods

We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20 ml/min/1.73 m² after 1 year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1 year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline.

Results

Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m²/year. Children (n = 35) and adults (n = 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance.

Conclusion

PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.

Graphical abstract

中文翻译：

儿童和成人后尿道瓣膜 (PUV) 患者的肾脏疾病进展

背景

后尿道瓣膜 (PUV) 是男孩梗阻性尿路病的最常见原因；大约 15% 的人在成年早期出现肾衰竭。然而，PUV 儿童和成人的肾功能下降率以及潜在可改变的慢性肾病 (CKD) 进展危险因素的影响尚不清楚。

方法

我们对 1995 年至 2018 年在我们机构随访的所有 PUV 患者进行了回顾性审查。纳入标准为 1 岁后估计肾小球滤过率 (eGFR) > 20 ml/min/1.73 m ² ，无透析或肾移植史， 1 岁后每年血清肌酐值≥2。 eGFR 使用基于肌酐的儿童 (CKID U25) 或成人 (CKD-EPI) 估算公式计算。主要结果是 eGFR 的年化变化，采用线性混合效应模型进行评估。我们还研究了急性肾损伤 (AKI)、蛋白尿、高血压 (HTN) 和复发性发热性尿路感染 (UTI) 与 eGFR 下降的关系。

结果

52 名 PUV 患者符合纳入标准。 eGFR 下降中位数（四分位距）为 2.6 (2.1, 3.1) ml/min/1.73 m ² /年。儿童 ( n = 35) 和成人 ( n = 17) 表现出进行性衰退。蛋白尿和复发性尿路感染与更快的进展显着相关； AKI 和 HTN 也有相关性，但未达到显着性。