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PEDIATRICS Vol. 107 No. 5 May 2001, pp. 1004-1010

Obstructive Nephropathy in Children: Long-Term Progression After Relief of Posterior Urethral Valve

Received Jan 24, 2000; accepted Aug 28, 2000.

Karl S. Roth*, Dagger , W. Hans Carter Jr§, and James C. M. Chan*, Dagger

From the Departments of * Pediatrics, Dagger  Biochemistry Molecular Biophysics, and § Biostatistics, Virginia Commonwealth University, Richmond, Virginia.

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.  Key words:  posterior urethral valve, obstructive nephropathy, progression.


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