Risk Factors for Early Chronic Kidney Disease IV–V in Children with Posterior Urethral Valves: A Retrospective Cohort Study

A BSTRACT Introduction: Only a few studies exist on the risk factors for early progression to chronic kidney disease (CKD) IV–V in children with posterior urethral valves (PUV) following surgery. Materials and Methods: All children between age of 1 month and 14 years diagnosed with PUV were enrolled and their records were reviewed. Results: n = 44 children enrolled. 15 (34.09%) progressed to CKD IV-V at <5 years of age. Median age of progression 16 months (interquartile range [IQR] 13.08). 28 (63.64%) detected antenatally. Median postnatal age of diagnosis was 5.5 months (IQR 23.13). Mean age at initial management was 5.36 ± 8.30 months in children with CKD IV–V and 4.11 ± 8.56 months in children with CKD I–III ( P = 0.65). Postoperative serum creatinine >1 mg/dl was seen in five children with CKD I–III and in 11 children with CKD IV–V. Routine check cystoscopy after 3–6 months revealed residual valves in 11.17 required additional surgeries. 10 with CKD I–III had no renal scarring on DMSA and 19 had unilateral renal scarring. In children with CKD IV–V, two had poorly functioning single kidney with scarring, seven had bilateral renal scarring and DMSA was not done in six children due to severe bilateral dysfunction. On univariate logistic regression, postoperative serum creatinine >1 mg/dl and the presence of bilateral renal scarring on DMSA was significantly associated with early progression to CKD IV–V while additional surgeries had significant protective influence. On multivariate logistic regression, bilateral renal scarring and additional surgeries are significant protection. Conclusions: Bilateral kidney scarring on DMSA scan is a significant risk factor for early progression, whereas additional surgeries have a protective influence.