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• W2091728771 abstract "No AccessJournal of UrologyPediatric Urology1 Jun 2011Renal Function Reserve in Children With Posterior Urethral Valve: A Novel Test to Predict Long-Term Outcome M.S. Ansari, R. Surdas, S. Barai, Aneesh Srivastava, and Rakesh Kapoor M.S. AnsariM.S. Ansari More articles by this author , R. SurdasR. Surdas More articles by this author , S. BaraiS. Barai More articles by this author , Aneesh SrivastavaAneesh Srivastava More articles by this author , and Rakesh KapoorRakesh Kapoor More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.041AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Commonly used measures such as serum creatinine level and glomerular filtration rate do not actually reflect decreased total number of nephrons. There is a need to identify early the subset of patients who are at increased risk for renal failure. Materials and Methods: We studied children diagnosed with posterior urethral valve at our institution between August 2007 and December 2008. Renal function reserve was measured at least 6 weeks after initial fulguration of posterior urethral valve. Glomerular filtration rate was obtained by calculating plasma clearance of 99mtechnetium labeled diethylenetriamine pentaacetic acid. Renal function reserve was calculated as the difference between stimulated (after protein load) and baseline glomerular filtration rate, and reported as percentage increase in baseline glomerular filtration rate. Patients were divided into 2 groups depending on the presence (group 1) or absence (group 2) of renal function reserve. Less than 10% increase in renal function reserve after protein load was defined as absence of renal function reserve. Results: A total of 25 children with a median age of 30 months (range 24 to 60) were studied. Median serum creatinine at presentation and nadir value were 1.53 mg/dl (range 0.6 to 4.0) and 0.75 mg/dl (0.6 to 1.0), respectively. Mean ± SD baseline glomerular filtration rate was 59.88 ± 10 ml/min/1.73 m2 body surface area (range 22 to 124). Mean protein load induced renal function reserve was 32.23% (range 2.3% to 96.70%). After protein load glomerular filtration rate increased in 16 patients (64%) by a mean of 32.23%, remained unchanged in 4 (16%) and decreased in 5 (20%) by a mean of 12.5%. Patients with absent renal function reserve had a greater degree of bladder dysfunction on urodynamic study and more severe vesicoureteral reflux (grade III or higher, p <0.05). At a median followup of 13 months (range 7 to 36) median serum creatinine was 0.78 mg/dl and 1.3 mg/dl in the 2 groups, respectively (p <0.05). Conclusions: In more than a third of patients with posterior urethral valves renal function reserve is completely depleted at presentation. Decreased or absent renal function reserve may be used as an early indicator of long-term renal deterioration. References 1 North American Pediatric Renal Transplant Cooperative Study (NAPRTCS): 2005 Annual Report. Rockville, Maryland: EMMES Corp2005. Google Scholar 2 : Epidemiology of chronic renal failure in children: data from the ItalKid project. Pediatrics2003; 111: e382. Google Scholar 3 : The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol1996; 155: 1730. Link, Google Scholar 4 : Boys with posterior urethral valves: outcome concerning renal function, bladder function and paternity at ages 31 to 44 years. J Urol2005; 174: 1031. Link, Google Scholar 5 : Posterior urethral valves in Eastern Ontario—a 30 year perspective. Can J Urol2004; 11: 2210. Google Scholar 6 : Risk factors for progression to end-stage renal disease in children with posterior urethral valves. J Pediatr Urol2010; 6: 261. 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Google Scholar 20 : In term infants, GFR doubles after 2 weeks of age, reaching adult levels by 2 years of age: Glomerular circulation and function . In: Pediatric Nephrology. Edited by . Philadelphia: Lippincott Williams and Wilkins2004: 25. Google Scholar 21 : Measurement of glomerular filtration rate: single injection plasma clearance method without urine collection. J Nucl Med1985; 26: 1243. Google Scholar 22 : Short-term protein loading in assessment of patients with renal disease. Am J Med1984; 77: 873. Google Scholar 23 : Renal functional reserve in children with and without renal disease. Nephron1991; 59: 1. Google Scholar 24 : Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation. Am J Physiol1981; 241: F85. Google Scholar 25 : Short-term protein loading in assessment of patients with renal disease. Am J Med1984; 77: 873. Google Scholar 26 : Response to acute protein load in kidney donors and in apparently normal post acute glomerulonephritis patients: evidence for glomerular hyperfiltration. Lancet1985; 2: 461. Google Scholar 27 : Short-term effect of low and high protein intake on renal function in children with renal disease. Acta Paediatr Scand1987; 76: 288. Google Scholar Departments of Urology and Renal Transplantation, and Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India© 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 6June 2011Page: 2329-2333 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.Keywordskidney failureurethrarenal insufficiencypreschoolchildchronicMetricsAuthor Information M.S. Ansari More articles by this author R. Surdas More articles by this author S. Barai More articles by this author Aneesh Srivastava More articles by this author Rakesh Kapoor More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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