ESPN 50th Annual Meeting

ESPN 2017


 
Diagnosis, management and outcome of posterior urethral valves in children at a tertiary centre in South Africa
MICHELO SHARON CHOOPA 1 SAMUEL O MANDA 2 GERTRUIDA VAN BILJON 1

1- PAEDIATRIC NEPHROLOGY UNIT, UNIVERSITY OF PRETORIA, STEVE BIKO ACADEMIC HOSPITAL, PRETORIA, SOUTH AFRICA
2- BIOSTATISTICS RESEARCH UNIT, SOUTH AFRICAN MEDICAL RESEARCH COUNCIL, SOUTH AFRICA & SCHOOL OF MATHEMATICS, STATISTICS AND COMPUTER SCIENCE, UNIVERSITY OF KWAZULU-NATAL, SOUTH AFRICA
 
Introduction:

One of the most common causes of congenital abnormalities of the kidneys and urinary tract is posterior urethral valves (PUV). This can easily be diagnosed by third trimester scan which leads to better prognosis. However, in resource-limited environments, the diagnosis is often missed or made late upon presentation with life-threatening clinical features. The study aimed to review the age at diagnosis, management and outcomes of PUV in children in a tertiary hospital in South Africa.

Material and methods:

All files of children who were referred to the Paediatric Nephrology Unit at Steve Biko Academic Hospital in Pretoria, South Africa, from January 2000 to December 2015 were retrospectively reviewed. Data extracted included: antenatal diagnosis of PUV, age at diagnosis postnatally, presence of acute kidney injury at diagnosis, management, complications and outcomes i.e. chronic kidney disease (CKD) or death.

Results:

A total of 62 boys with a mean and median age at diagnosis of 21.7 and 3.5 months respectively, had PUV. Micturating cystourethrograms were done in 81% of patients. Sonar reports showed that 18% of patients had renal dysplasia. Primary valve ablation was conducted in 36% of patients while diversions (vesicostomies, nephrostomies and ureterostomies) were done in 50% of patients. The commonest presenting clinical features were urinary retention 28/62 (45%), failure to thrive 15/62 (24%), urinary tract infections 6/62 (10%). 58% presented with associated acute kidney injury. 18/52 (36%) had CKD, 16/62 (26%) had hypertension and 6/16 (37%) had proteinuria at follow-up. Only 6/60 (10%) were diagnosed antenatally.

Conclusions:

A deliberate policy to have third trimester antenatal scans may improve outcome of affected children.