Future risks of chronic kidney disease and end-stage kidney disease in infants with postnatally-repaired posterior urethral valve: A systematic review

Abstract

Background and Objectives: Several studies show that most infants with posterior urethral valve (PUV) do not fully recover their renal function, despite postnatal interventions to obviate the consequences of lower urinary tract obstruction. This systematic review assesses the future risks of chronic kidney disease (CKD) and end-stage kidney disease (ESKD) in infants with postnatally-repaired PUV. Methods: We electronically searched PubMed, Medline, Embase, and Google Scholar databases for articles published between 2000 and 2020 (Date of the last search: September 12, 2020) using appropriate descriptors. We selected the studies based on adopted eligibility and exclusion criteria. We independently retrieved relevant data from the selected studies using a preconceived data-extraction form. We analyzed the aggregate data among the selected studies that signified future CKD and ESKD after the postnatal intervention and computed their mean prevalence rates. We also calculated the average point estimate of CKD and ESKD relative risks (RR) as the effect estimate at a 95% confidence interval. Results: Eleven studies were selected and reviewed, in which a total of 1362 patients were managed and followed up for variable periods. The aggregate data on ESKD prevalence from seven studies showed that a total of 112 patients developed ESKD out of a total patient-population of 446, giving a calculated mean ESKD prevalence of 24%. The CKD prevalence data in nine studies showed that 210 patients had CKD, out of 741 patients that were followed up, with a calculated mean CKD prevalence of 28%. The pooled RR of ESKD in seven studies and RR of CKD in nine studies was 0.5 (−0.48, 1.48) and 0.57 (−0.41, 1.55), respectively. Conclusions: Future risks of CKD and ESKD are still high in patients with postnatally-repaired PUV. We advocate a management approach that involves a synergy between pediatric nephrologists and urologists to ensure prompt renoprotective strategies and timely surgical intervention.