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Arredondo Montero J, Pérez Riveros BP, Rico Jiménez M, Bueso Asfura OE, Martín-Calvo N. Pop-off mechanisms as renoprotective mediators in children with posterior urethral valves: A systematic review and meta-analysis. J Pediatr Urol 2024; 20:57-66. [PMID: 37852807 DOI: 10.1016/j.jpurol.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/07/2023] [Accepted: 10/01/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Pop-off mechanisms are potential pressure-relieving mediators in patients diagnosed with posterior urethral valves (PUV). This systematic review aimed to synthesize the existing evidence regarding the protective effect of pop-off mechanisms on renal function in children with PUV. METHODS We conducted a systematic review of the literature that involved an extensive search in the main databases of the medical bibliography. Three independent reviewers selected the relevant articles. Methodological quality was rated using the Newcastle Ottawa Scale index. We used random meta-analyses to compare different outcomes (serum creatine, Nadir serum creatinine, and Chronic Kidney Disease) between children with PUV and pop-off mechanisms and those with PUV without pop-off mechanisms. RESULTS 10 studies with data from 896 participants were included in this review. Seven articles reported serum creatinine values for each group and 3 of them found significant differences between groups. The random-effects meta-analysis for serum creatinine showed significant lower mean (diff = -52.88 μmol/L [95 % CI -73.65 to -32.11]) in the group of children with pop-off mechanisms, and the random-effects meta-analysis for Nadir serum creatinine showed a marginally significantly lower mean in the group of children with pop-off mechanisms (diff = -12.00 μmol/L [95 % CI -24.04 to 0.04]). The random-effect meta-analysis for Chronic Kidney Disease resulted in a significant risk reduction for the group of children with pop-off mechanisms (odds ratio = 0.48 [95 % CI 0.23 to 0.98]). CONCLUSIONS Children with PUV and pop-off mechanisms show better renal function and lower risk of Chronic Kidney Disease than those with PUV without pop-off mechanisms suggesting these mechanisms may act as renoprotective mediators. The high heterogeneity between studies in the assessment of renal function and long-term outcomes calls for a cautious interpretation of these findings. Future studies that stratify by different types of pop-off mechanisms and use standardized metrics, such as Nadir creatinine, are needed.
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Affiliation(s)
- Javier Arredondo Montero
- Pediatric Surgery Department, Complejo Asistencial Universitario de León, León, Spain; University of Navarra, School of Medicine, Department of Preventive Medicine and Public Health, Pamplona, Navarra, Spain.
| | - Blanca Paola Pérez Riveros
- University of Navarra, School of Medicine, Department of Preventive Medicine and Public Health, Pamplona, Navarra, Spain
| | - María Rico Jiménez
- University of Navarra, School of Medicine, Department of Preventive Medicine and Public Health, Pamplona, Navarra, Spain
| | - Oscar Emilio Bueso Asfura
- University of Navarra, School of Medicine, Department of Preventive Medicine and Public Health, Pamplona, Navarra, Spain
| | - Nerea Martín-Calvo
- University of Navarra, School of Medicine, Department of Preventive Medicine and Public Health, Pamplona, Navarra, Spain; IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Navarra, Spain; CIBER de Fisiopatología de la Obesidad y la Nutrición, Instituto de Salud Carlos III, Madrid, Spain
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Griffith AM, Woodward PJ, Kennedy AM. Troubleshooting Tips for Diagnosing Complex Fetal Genitourinary Malformations. Radiographics 2024; 44:e230084. [PMID: 38127660 DOI: 10.1148/rg.230084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Fetal genitourinary anomalies can present a diagnostic challenge for the radiologist. The absence of a normally located kidney may represent agenesis or be secondary to a fusion or migration abnormality. A dilated renal pelvis should prompt evaluation for a specific cause, including ureteropelvic junction obstruction, reflux, or an obstructed duplicated system. Cystic parenchymal changes are characteristic of a multicystic dysplastic kidney but may also be seen in obstructive cystic dysplasia. There are numerous causes of megacystis including chromosomal (trisomy 18 syndrome), obstruction (posterior urethral valves, urethral atresia), or muscular dysfunction (prune belly syndrome, megacystis microcolon intestinal hypoperistalsis syndrome). Important mimics of a large bladder include hydrocolpos and urogenital sinus or cloacal malformation. Complications of genitourinary malformations are common and include oligohydramnios, urinary ascites, and urinoma. Making an accurate diagnosis often requires additional US views beyond those obtained in the standard fetal survey and occasionally performing fetal MRI. The appropriate use of orthogonal T2-weighted sequences, in conjunction with diffusion-weighted images for evaluation of the kidneys and gradient-recalled-echo sequences for evaluation of T1-hyperintense meconium in the colon, can play an integral role in diagnosis. Accurate diagnosis of fetal genitourinary malformations is vital to direct patient counseling and pregnancy management as outcomes are highly variable. Some conditions can be surgically corrected quite simply, some require multiple complex procedures, and some are lethal. The authors offer troubleshooting tips to narrow the differential diagnosis for four observations: unilateral absent kidney, dilated renal pelvis, cystic renal parenchyma, and megacystis and its mimics. ©RSNA, 2023 Test Your Knowledge questions are available in the Online Learning Center.
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Affiliation(s)
- April M Griffith
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
| | - Paula J Woodward
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
| | - Anne M Kennedy
- From the Department of Radiology and Imaging Sciences, University of Utah Health, 30 N Mario Capecchi Dr, 2nd Floor South, Salt Lake City, UT 84112
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Khondker A, Kim K, Najafabadi BT, Nguyen DD, Kim JK, Yadav P, Brownrigg N, Richter J, E Chua M, Dos Santos J, Rickard M, Lorenzo AJ. Posterior urethral valves, pressure pop-offs, and kidney function: systematic review and meta-analysis. World J Urol 2023; 41:1803-1811. [PMID: 37330439 DOI: 10.1007/s00345-023-04451-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/18/2023] [Indexed: 06/19/2023] Open
Abstract
PURPOSE To determine the role of pressure pop-off mechanisms, including vesicoureteral reflux and renal dysplasia (VURD) syndrome, in determining long-term kidney outcomes in boys with posterior urethral valves (PUV). METHODS A systematic search was performed in December 2022. Descriptive and comparative studies with a defined pressure pop-off group were included. Assessed outcomes included end-stage renal disease (ESRD), kidney insufficiency (defined as chronic kidney disease [CKD] stage 3 + or SCr > 1.5 mg/dL), and kidney function. Pooled proportions and relative risks (RR) with 95% confidence intervals (CI) were extrapolated from available data for quantitative synthesis. Random-effects meta-analyses were performed according to the study design and techniques. The risk of bias was assessed with the QUIPS tool and GRADE quality of evidence. The systematic review was prospectively registered on PROSPERO (CRD42022372352). RESULTS A total of 15 studies describing 185 patients with a median follow-up of 6.8 years were included. By the last follow-up, overall effect estimates demonstrate the prevalence of CKD and ESRD to be 15.2% and 4.1%, respectively. There was no significant difference in the risk of ESRD in patients with pop-off compared to no pop-off patients [RR 0.34, 95%CI 0.12, 1.10; p = 0.07]. There was a significantly reduced risk for kidney insufficiency in boys with pop-off [RR 0.57, 95%CI 0.34, 0.97; p = 0.04], but this protective effect was not re-demonstrated after excluding studies with inadequate reporting of CKD outcomes [RR 0.63, 95%CI 0.36, 1.10; p = 0.10]. Included study quality was low, with 6 studies having moderate risk and 9 having a high risk of bias. CONCLUSIONS Pop-off mechanisms may be associated with reducing the risk of kidney insufficiency, but current certainty in the evidence is low. Further research is warranted to investigate sources of heterogeneity and long-term sequelae in pressure pop-offs.
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Affiliation(s)
- Adree Khondker
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Kellie Kim
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - David-Dan Nguyen
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Jin Kyu Kim
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Priyank Yadav
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Natasha Brownrigg
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Juliane Richter
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Michael E Chua
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Joana Dos Santos
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Mandy Rickard
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Armando J Lorenzo
- Division of Urology, Department of Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
- Division of Urology, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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Paraboschi I, Giannettoni A, Mantica G, Polymeropoulos A, Mishra P, Clothier J, Garriboli M. Posterior Urethral Valves, Unilateral Vesicoureteral Reflux, and Renal Dysplasia (VURD) Syndrome: Long-Term Longitudinal Evaluation of the Kidney Function. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6238. [PMID: 37444086 PMCID: PMC10341772 DOI: 10.3390/ijerph20136238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/11/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023]
Abstract
The presence of unilateral vesicoureteral reflux (VUR), and renal dysplasia associated with posterior urethral valves (PUV) (VURD syndrome) was believed to represent a pressure-released pop-off mechanism protecting kidney function. We aimed to investigate its role with respect to long-term kidney function in a cross-sectional and longitudinal analysis. We compared the iohexol glomerular filtration rate (GFR) measured at 5 (GFR5) and 10 (GFR10) years of age in children with (Group A) and without (Group B) VURD syndrome, who underwent PUV resection under 2 years of age. VURD syndrome was diagnosed in cases of unilateral loss of kidney function (<15% on nuclear medicine test) associated with ipsilateral grade IV-V VUR. VURD syndrome was diagnosed in 16 (12.8%) out of 125 patients who met the inclusion criteria. While the median GFR5 was similar in the 2 groups [Group A: 87.3 (74.7-101.2) mL/min/1.73 m2 vs. Group B: 99.6 (77-113) mL/min/1.73 m2, p-value: 0.181], the median GFR10 values were significantly lower in children with VURD syndrome [Group A: 75.7 (71.2-85.9) mL/min/1.73 m2 vs. Group B: 95.1 (81.2-114.2) mL/min/1.73 m2, p-value: 0.009]. Similar results were obtained in a longitudinal analysis of the children with GFR measurement available both at 5 and 10 years of age [GFR5 in Group A: 93.1 (76.9-103.5) mL/min/1.73 m2 vs. Group B: 97.5 (80-113) mL/min/1.73 m2, p-value: 0.460; GFR10: Group A: 71.9 (71.9-85.9) mL/min/1.73 m2 vs. Group B: 94.8 (81.5-110.6) mL/min/1.73 m2, p-value: 0.024]. In conclusion, VURD syndrome does not show a protective role in kidney function preservation. On the contrary, it seems to be associated with a deterioration of the kidney function on a long-term follow-up.
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Affiliation(s)
- Irene Paraboschi
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Department of Pediatric Urology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 28, 20122 Milan, Italy
| | - Adele Giannettoni
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Guglielmo Mantica
- Department of Urology, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alexios Polymeropoulos
- Department of Statistics ad Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Pankaj Mishra
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Joanna Clothier
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
| | - Massimo Garriboli
- Pediatric Nephro-Urology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Stem Cells & Regenerative Medicine Section, Developmental Biology & Cancer Programme, UCL Institute of Child Health, London WC1N 1EH, UK
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