Prognostic factors in prenatally-detected posterior urethral valves: a multivariate analysis.
To identify prognostic factors associated with chronic renal insufficiency in children with posterior urethral valves (PUV), 22 children with PUV were submitted to a systematic protocol and prospectively followed. Prognostic factors associated with fetal echography and clinical and laboratory findings were studied on admission. Median follow-up was 76 months. The analysis was conducted in two steps: in univariate analysis, variables associated with adverse outcome were identified by the Kaplan-Meier method. The variables that were significantly associated with adverse outcome were then included in a multivariate analysis using the Cox model. Eleven patients (50%) developed chronic renal failure (CRF) during follow-up. After adjustment by the multivariate model, four factors were identified as independent predictors of adverse outcome: oligohydramnios (relative risk [RR] = 10.6, 95% CI = 2.7 - 77, P = 0.02), ventilatory support (RR = 6, 95% CI = 2 - 24, P = 0.01), urea higher than 40 mg/dl (RR = 3.7, 95% CI = 0.92 - 15.0, P = 0.06), and bilateral vesicoureteral reflux (VUR) (RR = 6.1, 95% CI = 1.25 - 30, P = 0.02). On the other hand, the presence of unilateral VUR was a protective factor against the development of CRF or death during follow-up (RR = 0.92, 95% CI = 0.87 - 0.98, P = 0.05).
Oliveira
Eduardo A
EA
Pediatric Nephrourology Unit, Department of Pediatrics, Hospital das Clínicas, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil. eduolive@medicina.ufmg.br
Rabelo
Eli A S
EA
Pereira
Alamanda K
AK
Diniz
José S
JS
Cabral
Antônio C V
AC
Leite
Henrique Vitor
HV
Silva
José M P
JM
Fagundes
Tiago A
TA
D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging / Q000196:embryology / Q000473:pathology*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D016216:Ultrasonography, Prenatal; D014521:Urethra / Q000002:abnormalities*