INTRODUCTION AND OBJECTIVES: Posterior urethral valves (PUVs) represent the most common obstructive uropathy in children with a broad spectrum of clinical severity. Herein, we evaluated the prognostic variables affecting the outcome of renal function in such children.

METHODS: Between 1987 and 2004, 120 cases of PUVs with a mean age of 2 years were treated initially at our center with valve ablation. We studied the following parameters: age at presentation, serum creatinine (initial, nadir), initial creatinine clearance, renal ultrasound findings (hydronephrosis, renal parenchymal echogenicity), vesicoureteral reflux on initial voiding cystourethrogram (VCUG), pop-off mechanisms (VURD, Large vesical diverticulum, Urinoma, Ascitis) and bladder dysfunction. Long-term renal outcome was assessed.

RESULTS: Follow up ranged from 2 to 16 years (Mean ¡À SD = 4.4 ¡À2.6). Renal insufficiency developed at the end of follow up in 44 patients (36.5%). Serum creatinine on admission, nadir serum creatinine, initial creatinine clearance and renal parenchymal echogenicity were significant predictors for the final renal outcome (p < 0.05). While, patient age at diagnosis (¡Ü 2 versus > 2 years), upper tract dilatation, presence or absence of vesicoureteral reflux, pop-off mechanisms and bladder dysfunction had no significant impact on future renal function. In multivariate analysis, nadir serum creatinine was the only independent prognostic factor.

CONCLUSIONS: Our data confirm the high prognostic value of nadir creatinine after primary valve ablation. Also the initial serum creatinine, creatinine clearance and renal parenchymal echogenicity on initial renal ultrasound correlate significantly with long term renal function in children with PUVs.

Source of Funding: None