ESPN 50th Annual Meeting

ESPN 2017


 
ADOLESCENTS WITH POSTERIOR URETHRAL VALVES: KIDNEY AND BLADDER FUNCTION AT TRANSITION TO ADULT CARE.
Michal Maternik 1 Chudzik Ilona 1 Andrzej Golebiewski 2 Aleksandra Zurowska 1

1- Department Paediatrics, Nephrology and Hypertension, Medical University of Gdansk, Poland.
2- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Poland.
 
Introduction:

The short-term prognosis for boys with posterior urethral valves (PUV) has improved in recent decades, but the long-term outcome for kidney and bladder function are not well defined. Boys with PUV are followed from birth till 16-18 years of age by pediatric nephrologists and urologists. The kidney and bladder function of this cohort has not been clearly defined at this sensitive time of transition to adult care.

Material and methods:

The data of 41 boys with PUV were analyzed at time of transition to adult care. The  average time of observation following  valve ablation was  16 years (15-18yrs). Outcome measures were defined as kidney and urinary tract damage or loss of function. Kidney damage was assessed by ultrasound (lack of corticomedullary differentiation and hydronephrosis) and kidney function by eGFR (MDRD calculation) with KDOQI categorization of Chronic Kidney Disease (CKD). Bladder function was assessed by bladder diary and uroflow measurements (presence of increased bladder capacity and significant post void residual (PVR)).

Results:

83% (34/ 41) of subjects developed CKD. The majority (49%) had CKD1 with normal eGFR , the remaining 34% had decreased eGFR (17%-CKD2, 7%-CKD3, 2%-CKD4 , 5%-CKD5). 29% (12/41) received antihypertensive treatment. Kidney ultrasound showed loss of corticomedullary differentiation in 60% (25/41) and persistent hydronephrosis in 51% (21/41) of the cohort. Incontinence was reported by 24% (10/41). Uroflow measurements revealed  a bladder capacity above 150% of EBC (expected bladder capacity for age) in 19 (46%) and PVR greater than 10% of bladder capacity in 13 (31%).

 

Conclusions:

83% boys with PUV have CKD and 46% have bladder dysfunction at time of transition to adult care. Adolescent boys with PUV require close surveillance and active treatment when transferred to adult nephrology and urology care due to the high risk of developing both ESRD and bladder insufficiency.