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Huang VW, Behairy M, Abelson B, Crane A, Liu W, Wang L, Dell KM, Rhee A. Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients. Pediatr Nephrol 2024; 39:829-835. [PMID: 37658873 DOI: 10.1007/s00467-023-06128-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors. METHODS We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20 ml/min/1.73 m2 after 1 year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1 year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline. RESULTS Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m2/year. Children (n = 35) and adults (n = 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance. CONCLUSION PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.
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Affiliation(s)
- Victoria W Huang
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Mohga Behairy
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | | | - Alice Crane
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
| | - Wei Liu
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Lu Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA
| | - Katherine M Dell
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.
- Department of Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
- Center for Pediatric Nephrology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA.
| | - Audrey Rhee
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Urology, Cleveland Clinic, Cleveland, OH, USA
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Walawender L, Becknell B, Matsell DG. Congenital anomalies of the kidney and urinary tract: defining risk factors of disease progression and determinants of outcomes. Pediatr Nephrol 2023; 38:3963-3973. [PMID: 36867265 PMCID: PMC10914409 DOI: 10.1007/s00467-023-05899-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/23/2023] [Accepted: 01/30/2023] [Indexed: 03/04/2023]
Abstract
Congenital anomalies of the kidney and urinary tract (CAKUT) result from disruptions in normal kidney and urinary tract development during fetal life and collectively represent the most common cause of kidney failure in children worldwide. The antenatal determinants of CAKUT are diverse and include mutations in genes responsible for normal nephrogenesis, alterations in maternal and fetal environments, and obstruction within the normal developing urinary tract. The resultant clinical phenotypes are complex and depend on the timing of the insult, the penetrance of underlying gene mutations, and the severity and timing of obstruction related to the sequence of normal kidney development. Consequently, there is a broad spectrum of outcomes for children born with CAKUT. In this review, we explore the most common forms of CAKUT and those most likely to develop long-term complications of their associated kidney malformations. We discuss the relevant outcomes for the different forms of CAKUT and what is known about clinical characteristics across the CAKUT spectrum that are risk factors of long-term kidney injury and disease progression.
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Affiliation(s)
- Laura Walawender
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian Becknell
- Kidney and Urinary Tract Center, The Abigail Wexner Research Institute at Nationwide Children's, Columbus, OH, USA
- Division of Nephrology and Hypertension, Nationwide Children's Hospital, Columbus, OH, USA
| | - Douglas G Matsell
- University of British Columbia, British Columbia Children's Hospital Research Institute, 4480 Oak Street, Vancouver, BC, Canada.
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Kwong JC, Khondker A, Kim JK, Chua M, Keefe DT, Dos Santos J, Skreta M, Erdman L, D'Souza N, Selman AF, Weaver J, Weiss DA, Long C, Tasian G, Teoh CW, Rickard M, Lorenzo AJ. Posterior Urethral Valves Outcomes Prediction (PUVOP): a machine learning tool to predict clinically relevant outcomes in boys with posterior urethral valves. Pediatr Nephrol 2022; 37:1067-1074. [PMID: 34686914 DOI: 10.1007/s00467-021-05321-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/11/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Early kidney and anatomic features may be predictive of future progression and need for additional procedures in patients with posterior urethral valve (PUV). The objective of this study was to use machine learning (ML) to predict clinically relevant outcomes in these patients. METHODS Patients diagnosed with PUV with kidney function measurements at our institution between 2000 and 2020 were included. Pertinent clinical measures were abstracted, including estimated glomerular filtration rate (eGFR) at each visit, initial vesicoureteral reflux grade, and renal dysplasia at presentation. ML models were developed to predict clinically relevant outcomes: progression in CKD stage, initiation of kidney replacement therapy (KRT), and need for clean-intermittent catheterization (CIC). Model performance was assessed by concordance index (c-index) and the model was externally validated. RESULTS A total of 103 patients were included with a median follow-up of 5.7 years. Of these patients, 26 (25%) had CKD progression, 18 (17%) required KRT, and 32 (31%) were prescribed CIC. Additionally, 22 patients were included for external validation. The ML model predicted CKD progression (c-index = 0.77; external C-index = 0.78), KRT (c-index = 0.95; external C-index = 0.89) and indicated CIC (c-index = 0.70; external C-index = 0.64), and all performed better than Cox proportional-hazards regression. The models have been packaged into a simple easy-to-use tool, available at https://share.streamlit.io/jcckwong/puvop/main/app.py CONCLUSION: ML-based approaches for predicting clinically relevant outcomes in PUV are feasible. Further validation is warranted, but this implementable model can act as a decision-making aid. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Jethro Cc Kwong
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Adree Khondker
- Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jin Kyu Kim
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Michael Chua
- Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Daniel T Keefe
- Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Marta Skreta
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Lauren Erdman
- Centre for Computational Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Neeta D'Souza
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - John Weaver
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dana A Weiss
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Christopher Long
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gregory Tasian
- Division of Urology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Chia Wei Teoh
- Division of Nephrology, Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of Urology, Department of Surgery, Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
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Chan MT, Chan EE, Ng YH, Yap T, Ong LY, Narasimhan KL, Jacobsen AS. Outcome of boys with posterior urethral valves from a single tertiary hospital in Singapore. ANZ J Surg 2022; 92:1159-1164. [DOI: 10.1111/ans.17445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Ming Tow Chan
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
| | - Esther Ern‐Hwei Chan
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
| | - Yong Hong Ng
- Department of Paediatrics KK Women's and Children's Hospital Singapore Singapore
| | - Te‐Lu Yap
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
| | - Lin Yin Ong
- Department of Paediatric Surgery KK Women's and Children's Hospital Singapore Singapore
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Urinary Beta-2-Microglobulin and Late Nephrotoxicity in Childhood Cancer Survivors. J Clin Med 2021; 10:jcm10225279. [PMID: 34830560 PMCID: PMC8622945 DOI: 10.3390/jcm10225279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/08/2021] [Accepted: 11/11/2021] [Indexed: 12/02/2022] Open
Abstract
The objectives of this study were to evaluate urinary beta-2-microglobulin (β2M) levels in long-term childhood cancer survivors and to establish its association with anticancer drug-induced nephrotoxicity. The study consisted of 165 childhood cancer survivors (CCS) who were in continuous complete remission. We reported that CCS had a significantly higher level of β2M (p < 0.001) and β2M/Cr. ratio (p < 0.05) than healthy peers. Among all participants, 24 (14.5%) had decreased eGFR (<90 mL/min/1.73 m2). A significant positive correlation between β2M/Cr. ratio and body mass index (coef. 14.48, p = 0.046) was found. Furthermore, higher levels of urinary β2M were detected among CCS with a longer follow-up time (over 5 years) after treatment. Subjects with decreased eGFR showed statistically higher urinary β2M levels (20.06 ± 21.56 ng/mL vs. 8.55 ± 3.65 ng/mL, p = 0.007) compared with the healthy peers. Twelve survivors (7.2%) presented hyperfiltration and they had higher urinary β2M levels than CCS with normal glomerular filtration (46.33 ± 93.11 vs. 8.55 ± 3.65 ng/mL, p = 0.029). This study did not reveal an association between potential treatment-related risk factors such as chemotherapy, surgery, radiotherapy, and the urinary β2M level. The relationship between treatment with abdominal radiotherapy and reduced eGFR was confirmed (p < 0.05). We demonstrated that urinary beta-2-microglobulin may play a role in the subtle kidney injury in childhood cancer survivors; however, the treatment-related factors affecting the β2M level remain unknown. Further prospective studies with a longer follow-up time are needed to confirm the utility of urinary β2M and its role as a non-invasive biomarker of renal dysfunction.
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Lesieur E, Barrois M, Bourdon M, Blanc J, Loeuillet L, Delteil C, Torrents J, Bretelle F, Grangé G, Tsatsaris V, Anselem O. Megacystis in the first trimester of pregnancy: Prognostic factors and perinatal outcomes. PLoS One 2021; 16:e0255890. [PMID: 34492029 PMCID: PMC8423287 DOI: 10.1371/journal.pone.0255890] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/26/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To determine whether bladder size is associated with an unfavorable neonatal outcome, in the case of first-trimester megacystis. MATERIALS AND METHODS This was a retrospective observational study between 2009 and 2019 in two prenatal diagnosis centers. The inclusion criterion was an enlarged bladder (> 7 mm) diagnosed at the first ultrasound exam between 11 and 13+6 weeks of gestation. The main study endpoint was neonatal outcome based on bladder size. An adverse outcome was defined by the completion of a medical termination of pregnancy, the occurrence of in utero fetal death, or a neonatal death. Neonatal survival was considered as a favorable outcome and was defined by a live birth, with or without normal renal function, and with a normal karyotype. RESULTS Among 75 cases of first-trimester megacystis referred to prenatal diagnosis centers and included, there were 63 (84%) adverse outcomes and 12 (16%) live births. Fetuses with a bladder diameter of less than 12.5 mm may have a favorable outcome, with or without urological problems, with a high sensitivity (83.3%) and specificity (87.3%), area under the ROC curve = 0.93, 95% CI (0.86-0.99), p< 0.001. Fetal autopsy was performed in 52 (82.5%) cases of adverse outcome. In the 12 cases of favorable outcome, pediatric follow-up was normal and non-pathological in 8 (66.7%). CONCLUSION Bladder diameter appears to be a predictive marker for neonatal outcome. Fetuses with smaller megacystis (7-10 mm) have a significantly higher chance of progressing to a favorable outcome. Urethral stenosis and atresia are the main diagnoses made when first-trimester megacystis is observed. Karyotyping is important regardless of bladder diameter.
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Affiliation(s)
| | - Mathilde Barrois
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Mathilde Bourdon
- Faculté de Médecine Paris Centre, Faculté de Santé, Université de Paris, Paris, France
- Service de Gynécologie-Obstétrique II et de Médecine de la Reproduction, AP-HP, Centre Hospitalier Universitaire (CHU) Cochin, Paris, France
- Department “Infection, Immunity and Inflammation”, Université de Paris, Institut Cochin, Paris, France
| | - Julie Blanc
- Service de Gynécologie Obstétrique, Hôpital Nord, AP-HM, Chemin des Bourrely, Marseille, France
- EA3279, CEReSS, Health Service Research and Quality of Life Center, Université Aix-Marseille, Marseille, France
| | - Laurence Loeuillet
- Service d’Histologie-Embryologie-Cytogénétique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Clémence Delteil
- Institut Médicolégal de Marseille, Hôpital Timone Adultes, Marseille, France
- CNRS, EFS, ADES UMR 7268, Aix-Marseille université, Marseille, France
| | - Julia Torrents
- Service d’Anatomo-Cytopathologie et Fœtopathologie, Hôpital de la Timone, Marseille, France
| | - Florence Bretelle
- Service de Gynécologie Obstétrique, Hôpital Nord, AP-HM, Chemin des Bourrely, Marseille, France
- Aix Marseille Univ, IRD, AP-HM, MEФI, Marseille, France
| | - Gilles Grangé
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Vassilis Tsatsaris
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
- Université de Paris, Inserm UMR-S 1139, Physiopathologie et Pharmacotoxicologie Placentaire Humaine, Paris, France
| | - Olivia Anselem
- Maternité Port-Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
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Kumar N, Yadav P, Jain S, Kumar G A, Kaushik VN, Ansari MS. Evaluation of polyuria and polydipsia along with other established prognostic factors in posterior urethral valves for progression to kidney failure: experience from a developing country. Pediatr Nephrol 2021; 36:1817-1824. [PMID: 33462698 DOI: 10.1007/s00467-020-04837-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/30/2020] [Accepted: 10/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Up to 50% of children with posterior urethral valves (PUV) progress to kidney failure. This study aimed to evaluate polyuria and polydipsia and other established variables with later development of kidney failure in children with PUV. METHODS Retrospective analysis of 297 children with PUV who underwent ablation of valves between January 1992 and January 2015 at our tertiary care center. Patients were divided into two groups: those who developed kidney failure (group 1) and those who did not (group 2). Specific prognostic factors for progression to kidney failure were analyzed including age at presentation < 1 year, nadir serum creatinine > 1.0 mg/dl, bilateral grade 3 or higher VUR at diagnosis, recurrent febrile UTIs, severe bladder dysfunction, polyuria, and polydipsia. RESULTS Thirty-eight (12.8%) patients progressed to kidney failure. Twenty-four and 64 patients were polyuric in group 1 and group 2 respectively (p < 0.001, Z-4.4666). Twenty-two and 61 patients were polydipsic in both groups respectively (p < 0.001). On univariate analysis, predicting variables were as follows: age at presentation < 1 year (p < 0.001), nadir serum creatinine > 1 mg/dl (p < 0.001), B/L high-grade VUR (p < 0.001), severe bladder dysfunction (p < 0.001), recurrent febrile UTIs (p = 0.002), polyuria (p < 0.001), and polydipsia (p < 0.001). On multivariate Cox regression analysis, severe bladder dysfunction, recurrent febrile UTIs, polyuria, and polydipsia were identified as significant prognostic factors predictive of ultimate progression to kidney failure. CONCLUSION Polyuria and polydipsia along with recurrent febrile UTI and bladder dysfunction are major prognostic factors affecting long-term kidney outcome in cases of PUV. Graphical abstract.
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Affiliation(s)
- Naveen Kumar
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Priyank Yadav
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Shrey Jain
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Abhay Kumar G
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Vinay N Kaushik
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - M S Ansari
- Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
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Safdar A, Singh K, Sun RC, Nassr AA. Evaluation and fetal intervention in severe fetal hydronephrosis. Curr Opin Pediatr 2021; 33:220-226. [PMID: 33651757 DOI: 10.1097/mop.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Fetal hydronephrosis secondary to congenital anomalies of the kidney and urinary tract (CAKUT) can adversely affect neonates in the postnatal period with long-term consequences. A prenatal diagnosis of CAKUT can have an early fetal intervention to minimize these consequences. This review aims to provide an overview of the possible fetal intervention with severe hydronephrosis. RECENT FINDINGS Clinical course and outcomes of CAKUT are predicted based on biochemical markers and radiological findings. In spite of advancements and accurately diagnosing the severity of hydronephrosis, there are many controversies surround on selection of cases with antenatal hydronephrosis (ANH) that will benefit from fetal intervention. Despite better diagnosis and techniques fetal intervention is limited to mainly lower urinary tract obstruction patients to improve amniotic fluid volume and assist in lung development. SUMMARY ANH can potentially detect the severity of congenital renal anomalies but unable to recognize a specific disease. A multidisciplinary approach is required to diagnose and properly stage cases of severe CAKUT and potential surgical intervention can be considered.
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Affiliation(s)
- Adnan Safdar
- Renal Section, Texas Children's Hospital, Baylor College of Medicine
| | - Kristianna Singh
- Renal Section, Texas Children's Hospital, Baylor College of Medicine
| | - Raphael C Sun
- Department of Surgery, Division of Pediatric Surgery, Texas Children's Hospital, Baylor College of Medicine
| | - Ahmed A Nassr
- Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Fetal Center, Houston, Texas, USA
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