Thesis (MMed)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: OBJECTIVES
The aim of this study was to determine long-term renal function in boys presenting
with posterior urethral valves at Tygerberg Children’s Hospital and to determine the
prognostic value of certain clinical, biochemical and radiological variables
DESIGN
Retrospective, descriptive study of boys diagnosed and treated with posterior
urethral valves at Tygerberg Children’s Hospital between 2001 and 2011.
RESULTS
Between 2001 and 2011, 47 cases of posterior urethral valves were diagnosed and
treated at our institution. Thirteen patients were excluded from this study. Seven
(20,6%) were diagnosed antenatally and 27 (79,4%) presented postnatally. Mean
age at presentation was 13,9 months (median 2; range 0-74). The most common
postnatal presentation was urinary tract infection (51,9%). Mean follow-up was 54,2
months (median 47,5; range 12-133). A total of 13 boys (38,2%) progressed to
chronic renal failure or end-stage renal disease. Initial and nadir serum creatinine,
poor corticomedullary differentiation and moderate-severe hydronephrosis were
significant predictors of final renal function (p<0,050). Patient age at presentation,
type of primary surgical intervention, increased renal echogenicity, bladder wall
thickness, the presence of vesicoureteric reflux (no matter what the laterality or
severity), severe bladder dysfunction and initial or breakthrough urinary tract
infection had no significant impact on future renal function. Receiver operating
characteristic curve analysis confirmed that boys with an initial serum creatinine
≥145μmol/L and a nadir serum creatinine ≥62μmol/L were at highest risk to develop
chronic renal insufficiency (area under the curve 0,8 and 0,9, respectively). CONCLUSION
More than a third of boys (38,2%) developed chronic renal failure or end-stage renal
disease at the end of follow-up. Our data confirmed the high prognostic value of
initial and nadir serum creatinine. Optimal threshold levels for initial and nadir
serum creatinine to predict final renal function were 145μmol/L and 62μmol/L,
respectively. Similarly, poor corticomedullary differentiation and moderate-severe
hydronephrosis on initial kidney ultrasound were significant indicators of poor renal
prognosis. Although all patients with posterior urethral valves should be counselled
on potential renal morbidity, children with risk factors warrant closer monitoring. / AFRIKAANSE OPSOMMING: DOELWITTE
Die doel van hierdie studie was om langtermyn nierfunksie te bepaal in seuns wat
gediagnoseer is met posterior uretrale kleppe by Tygerberg-kinderhospitaal. Die
prognostiese waarde van sekere kliniese, biochemiese en radiologiese veranderlikes
is ook ondersoek.
STUDIE ONTWERP
Retrospektiewe, beskrywende studie van seuns wat tussen 2001 en 2011 by
Tygerberg-kinderhospitaal gepresenteer het met posterior uretrale kleppe.
RESULTATE
Tussen 2001 en 2011 is 47 gevalle van posterior uretrale kleppe gediagnoseer en
behandel by ons instelling. Dertien pasiënte is uitgesluit van hierdie studie. Sewe
(20,6%) is met voorgeboorte sonar gediagnoseer en 27 (79,4%) het ná geboorte
gepresenteer. Die gemiddelde ouderdom by diagnose was 13,9 maande (mediaan 2;
reeks 0-74 ). Urienweginfeksie was die mees algemene metode waarmee postnatale
pasiënte gepresenteer het (51,9%). Die gemiddelde opvolgperiode was 54,2 maande
(mediaan 47,5; reeks 12-133). Dertien seuns (38,2%) het chroniese nierversaking of
eind-stadium nierversaking ontwikkel. Aanvanklike en nadir serumkreatinien, swak
kortiko-medullêre differensiasie en matig-erge hidronefrose was beduidende
voorspellers van finale nierfunksie (p<0,050). Pasiënt ouderdom met diagnose, tipe
chirurgiese ingryping, verhoogde niereggogenisiteit, blaaswanddikte,
vesikoureteriese refluks, blaasdisfunksie en aanvanklike of deurbraak
urienweginfeksies het geen beduidende impak op toekomstige nierfunksie gehad
nie. Seuns met 'n aanvanklike serumkreatinien ≥145μmol/L en 'n nadir
serumkreatinien ≥62μmol/L het die grootste risiko om chroniese nierversaking te
ontwikkel, soos bevestig met ‘n ROC-ontleding (AUC 0,8 en 0,9, onderskeidelik). GEVOLGTREKKING
Meer as 'n derde van die pasiënte (38,2%) het chroniese nierversaking of eindstadium
nierversaking ontwikkel. Ons data bevestig die prognostiese waarde van
aanvanklike en nadir serumkreatinienvlakke. Die optimale drempelwaardes vir die
aanvanklike en nadir serumkreatinien om finale nierfunksie te voorspel was
145μmol/L en 62μmol/L, onderskeidelik. Swak kortiko-medullêre differensiasie en
matig-erge hidronefrose op die aanvanklike niersonar was ook beduidende
aanwysers van toekomstige nierfunksie. Alhoewel alle pasiënte met posterior
uretrale kleppe berading moet ontvang oor potensiële niermorbiditeit, regverdig
seuns met risikofaktore noukeurige monitering.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/86726 |
| Date | 04 1900 |
| Creators | De Wet, Matthys Johannes |
| Contributors | Du Buisson, C. J., Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Paediatrics and Child Health. |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | 28 pages |
| Rights | Stellenbosch University |
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