Heikkila et al identified risk factors for end-stage renal disease (ESRD) in a patient treated for posterior urethral valves (PUV). These can help to identify a patient who may benefit from more aggressive management. The authors are from Hyvinkaa Hospital, Children’s Hospital, and University of Helsinki in Finland.
Patient selection: male treated for posterior urethral valves (PUV)
End-stage renal disease may present from childhood to early adulthood but did not occur in this population after age 34 years. The lifetime risk of ESRD was almost 30%.
Risk factors for end-stage renal disease:
(1) elevated nadir serum creatinine in the year after surgery to correct the PUV (indicating poor renal function)
(2) early presentation (antenatal, neonatal)
(3) pneumothorax
(4) bilateral vesicoureteral reflux (VUR)
(5) recurrent urinary tract infections after surgery to remove the obstruction
Nadir Serum Creatinine During First Year
Percent Progressing to ESRD
< 45 µmol/L
0%
> 97µmol/L
100%
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