Impact of urinary extravasation in posterior urethral valves: clinical implications of urinomas and ascites on kidney function.

IF 2.6 3区 医学 Q1 PEDIATRICS
Adree Khondker, Joana Dos Santos, Samer Maher, Michael Chua, Armando J Lorenzo, Mandy Rickard
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引用次数: 0

Abstract

Background: Urinary extravasation (UE) in patients with posterior urethral valves (PUV), in the form of urinomas or urinary ascites, is thought to represent a pop-off mechanism. Previous literature has proposed a kidney protective mechanism, although this remains controversial. Here, we performed a matched comparison to assess the effect of UE on kidney outcomes.

Methods: We retrospectively reviewed our PUV database, including all patients diagnosed < 3 months of age with at least 1-year follow-up. We collected demographics, management, vesicoureteral reflux (VUR) status, and kidney function parameters. UE was defined as postnatal urinoma or urinary ascites. We performed both unadjusted and propensity-matched comparisons of patients with and without UE. Matching was used to balance age, diversion status, urinary tract infection history, presence of VUR, and nadir creatinine. The primary outcomes were 1-, 3-, and 5-year kidney outcomes.

Results: Of the 138 patients meeting inclusion criteria, 27 (20%) had UE (23 urinoma, 4 urinary ascites). The median age at presentation was 5 days. Six patients (26%) required percutaneous drainage, and the median time to resolution was 21 days. Patients with UE had significantly higher initial creatinine levels but no difference in nadir values. Of those with available data, 18 (18%) and 10 (14%) had chronic kidney disease (CKD) at 3 and 5 years. Overall, there was no difference in 3- and 5-year rates of CKD between patients with and without a history of UE.

Conclusions: In a matched comparison, UE was not associated with long-term adverse or beneficial effects on kidney function. This study provides further evidence that the presence of UE may not be a relevant prognostic factor in children with PUV.

尿外渗对后尿道瓣膜的影响:尿瘤和腹水对肾功能的临床意义。
背景:后尿道瓣膜(PUV)患者的尿外渗(UE),以尿瘤或尿腹水的形式,被认为是一种弹出机制。先前的文献提出了肾脏保护机制,尽管这仍然存在争议。在这里,我们进行了一项匹配的比较来评估UE对肾脏预后的影响。结果:138例符合入选标准的患者中,27例(20%)有UE(23例尿瘤,4例尿腹水)。就诊时的中位年龄为5天。6例(26%)患者需要经皮引流,平均缓解时间为21天。UE患者的初始肌酐水平明显升高,但最低点没有差异。在有可用数据的患者中,分别有18(18%)和10(14%)在3年和5年时患有慢性肾脏疾病(CKD)。总体而言,有无UE病史的患者3年和5年CKD发生率无差异。结论:在一项匹配的比较中,UE与肾功能的长期不良或有益影响无关。这项研究提供了进一步的证据,表明UE的存在可能不是PUV患儿的相关预后因素。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Nephrology
Pediatric Nephrology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
20.00%
发文量
465
审稿时长
1 months
期刊介绍: International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.
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