Obstructive nephropathy in children: long-term progression after relief of posterior urethral valve.
| Autor: | Roth KS; Department of Pediatrics, Virginia Commonwealth University, Richmond, Virginia 23298-0498, USA., Carter WH Jr, Chan JC |
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| Jazyk: | angličtina |
| Zdroj: | Pediatrics [Pediatrics] 2001 May; Vol. 107 (5), pp. 1004-10. |
| DOI: | 10.1542/peds.107.5.1004 |
| Abstrakt: | Background: Approximately one third of children with end-stage renal disease have the illness because of urinary tract malformations, obstructive uropathy, and hypoplasia/dysplasia. The significant drop in infant mortality from obstructive uropathies in recent decades, attributable to prenatal diagnosis with renal ultrasonography and coordinated surgical and medical care, necessitated a reevaluation of the long-term outcome. Methods: To that end, we examined the long-term progression of obstructive nephropathy after neonatal relief of posterior urethral valves in our center over a span of 21 years, with diagnosis and care being provided by the same pediatric and urology team. Results: The 10 consecutive cases of posterior urethral valves represented 7% of all patients with congenital malformative uropathies seen over this period. The following procedures were performed: primary valve ablation (90%) and vesicostomy (40%). Seventy percent of patients progressed to end-stage renal disease over a (mean +/- standard error of the mean) follow-up of 11.3 +/- 2.1 years. The linear plot of the log of the inverse of serum creatinine versus time suggested unrelenting progression. The rate of progression was rapid after serum creatinine exceeded 5 mg/dL but the rate was slow and steady from serum creatinine of 1.5 to 5 mg/dL. Conclusions: To test the effect of a therapeutic intervention to ameliorate the rate of progression, this steady and prolonged progression of 0.5 mg/dL per year between serum creatinine concentration of 1.5 to 5 mg/dL would seem the optimal study. |
| Databáze: | MEDLINE |
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