Posterior urethral valves: risk factors of progression to end-stage chronic renal disease after 10 years of follow-up.

Abstract

Objective: To determine risk factors (RF) of progression to end-stage chronic renal disease (ESCRD) and the need for renal replacement therapy (RRT) in patients with posterior urethral valve (PUV).

Materials and methods: A retrospective case and control study of patients diagnosed with PUV in the 1995-2023 period was carried out. Two study groups were created -RRT vs. no-RRT. Clinical, laboratory, and radiological variables were collected. A bivariate analysis and a binary logistic regression were conducted to detect RFs of the need for RRT.

Results: 127 patients were included, 12.% of whom had undergone RRT (n= 20). Mean follow-up was 9.87 years. Mean age at clinical onset was younger in the RRT group (3 months vs. 1.23 years; p= 0.010). Pathological prenatal ultrasonography (p< 0.001), increased Nadir creatinine levels (p< 0.001) and maximum creatinine levels in the first year of life (p<  0.001), and onset with acute renal insufficiency (p= 0.03) were more frequent in the RRT group. Increased creatinine levels in the first week of life (OR: 4.74) and younger age at clinical onset (OR: 1.2) were the only independent RFs to predict the need for RRT. Diagnostic-therapeutic delay and the presence of UTIs during follow-up are not predictive of the risk of final RRT.

Conclusions: In PUV children, renal functional reserve at birth is the only ESCRD risk predictor. Early clinical onset implies a higher risk of RRT.