预测患有后尿道瓣膜的儿童慢性肾病的进展。

IF 2 3区 医学 Q2 PEDIATRICS Journal of Pediatric Urology Pub Date : 2024-11-22 DOI:10.1016/j.jpurol.2024.11.008
John K Weaver, Mandy Rickard, Corey Weinstein, Austin Thompson, Dennis Head, Erin Kim, Neeta D'Souza, Joseph Logan, Daniel Keefe, Lauren Erdman, Jessica Hannick, Lynn Woo, Karl Godlewski, Katherine Fischer, Christopher Long, Armando Lorenzo, Yong Fan, Dana Weiss
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引用次数: 0

摘要

目的:后尿道瓣膜(PUV)在一些儿童中导致早期慢性肾病(CKD)和肾功能衰竭,而另一些儿童甚至可以在成年后保持肾功能。我们的目的是评估puv患儿早期影像学特征与CKD进展之间的关系。我们假设在PRUS和VCUG上确定的影像特征与CKD的进展有关,并且不能与最低肌酐结合使用来预测未来的肾功能。方法:根据个别机构研究委员会的批准,我们在两个机构进行了回顾性队列研究。查询电子病历,以确定1990年至2022年间所有有puv治疗史的患者。在出生后一年内出现并在出生后90天内进行了首次膀胱超声(RBUS)和排尿膀胱尿道造影(VCUG)的儿童被纳入研究范围。主要结局CKD进展,定义为ESKD发展需要透析或肾移植或eGFR下降大于50%。感兴趣的临床变量包括:初始RBUS(尿瘤、囊性发育不良、孤立肾)的表现,出生后初始VCUG(程度和侧侧)的膀胱输尿管反流,以及最低点肌酐。单因素和多因素的Cox比例风险回归计算风险比(hr)。结果:537例puv患者中,274例符合纳入标准。中位随访时间为5.84年(IQR 2-10.2), 55名患者(20%)达到了我们的主要结局。多变量分析显示,存在任何程度的膀胱输尿管反流,HR为3.1 (95% CI 1.62-5.93),最低点肌酐为5.53 (95% CI 4-7.64),可预测CKD进展。当使用生命第一年的最低点肌酐作为CKD进展的唯一预测指标时,接受者-操作者曲线下面积为0.89 (95% CI 0.83-0.91)。结论:本研究证实了最低肌酸酐是puv患者CKD进展和ESKD的一个强有力的预测因子。在我们的队列中,膀胱输尿管反流的任何程度或侧边的存在也是CKD进展的重要预测因素。
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Predicting chronic kidney disease progression in children with posterior urethral valves.

Objective: Posterior urethral valves (PUV) leads to early chronic kidney disease (CKD) and renal failure in some children, while others may maintain preserved kidney function even into adulthood. Our goal was to assess the association between early imaging features and CKD progression in children with PUVs. We hypothesized that imaging features identified on PRUS and VCUG would be associated with CKD progression and could` be used in conjunction with nadir creatinine to predict future renal function.

Methods: Following individual institutional research board approvals, we performed a retrospective cohort study at two institutions. Electronic medical records were queried to identify all patients with a history of PUVs treated between 1990 and 2022. Children who presented in the first year of life and had their initial renal bladder ultrasound (RBUS) and voiding cystourethrogram (VCUG) performed within the first 90 days of life were included. The primary outcome, CKD progression, was defined as development of ESKD requiring dialysis or renal transplant or a decline in eGFR of greater than 50 %. Clinical variables of interest included: findings on initial RBUS (urinoma, cystic dysplasia, solitary kidney), vesicoureteral reflux on initial postnatal VCUG (degree and laterality), and nadir creatinine. Hazard ratios (HRs) were calculated from Cox proportional hazards regression for univariate and multivariable regression.

Results: Out of 537 patients with PUVs, 274 met our inclusion criteria. Median follow up was 5.84 years (IQR 2-10.2), and 55 patients (20 %) reached our primary outcome. Multivariable analysis showed the presence of any degree of vesicoureteral reflux, HR 3.1 (95 % CI 1.62-5.93), and nadir creatinine, HR 5.53 (95 % CI 4-7.64), were predictive of CKD progression When nadir creatinine within the first year of life is used as a sole predictor of CKD progression, the area under the receiver-operator curve was 0.89 (95 % CI 0.83-0.91).

Conclusions: This study confirms nadir creatinine as a strong predictor for CKD progression and ESKD in patients with PUVs. In our cohort, the presence of any degree or laterality of vesicoureteral reflux, was also a significant predictor for CKD progression.

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来源期刊
Journal of Pediatric Urology
Journal of Pediatric Urology PEDIATRICS-UROLOGY & NEPHROLOGY
CiteScore
3.70
自引率
15.00%
发文量
330
审稿时长
4-8 weeks
期刊介绍: The Journal of Pediatric Urology publishes submitted research and clinical articles relating to Pediatric Urology which have been accepted after adequate peer review. It publishes regular articles that have been submitted after invitation, that cover the curriculum of Pediatric Urology, and enable trainee surgeons to attain theoretical competence of the sub-specialty. It publishes regular reviews of pediatric urological articles appearing in other journals. It publishes invited review articles by recognised experts on modern or controversial aspects of the sub-specialty. It enables any affiliated society to advertise society events or information in the journal without charge and will publish abstracts of papers to be read at society meetings.
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