title: Abnormal antenatal sonogram: an indicator of disease severity in children with posterior urethral valves.
abstract: OBJECTIVE
  To review the association of an abnormal prenatal sonogram with most recent serum creatinine in patients with proven posterior urethral valves (PUV).
  
  
  METHODS
  Since 1992, all live-born patients between 1992-2004 with clinically proven PUV, with postnatally proven PUV, from 2 pediatric tertiary care centers, were reviewed for age at diagnosis, most recent serum creatinine, presence of chronic renal failure (CRF) (serum creatinine >2 standard deviations above normal for age), or end stage renal disease (dialysis or transplant). Available antenatal reports from the 2 centres and surrounding community hospitals were reviewed for gestational age (GA) at the time of ultrasound, volume of amniotic fluid, and urinary-tract abnormality.
  
  
  RESULTS
  Thirty-four patients with proven PUV and prenatal sonograms were identified (1992-2004). Eighteen patients had abnormalities on their prenatal sonogram, with poor outcome in 5 (mean follow-up, 8 years [1-13 y]). No specific features were identified on prenatal sonogram. Sixteen patients had normal prenatal sonograms, with poor outcomes in 2 (mean follow-up, 8 years [3-13y]). There is an increased risk of an abnormal serum creatinine among those patients with an abnormal prenatal study, odds ratio (OR) 2.6 (95% confidence interval, 0.35-32).
  
  
  CONCLUSIONS
  PUV represents a spectrum of disease severity. A normal prenatal ultrasound does not preclude PUV. The majority of patients with a normal prenatal examination have good outcomes. The OR suggests that there may be increased risk for poor outcome in those with an abnormal prenatal examination. A multicenter study is necessary to obtain a larger sample size and more precise ORs.
authors.affiliation: Department of Radiology, Peterborough Health Centre, Ontario, Canada.
authors.forename: Sarah
authors.initials: S
authors.lastname: Harvie
authors.forename: Lynne
authors.initials: L
authors.lastname: McLeod
authors.forename: Philip
authors.initials: P
authors.lastname: Acott
authors.forename: Eilish
authors.initials: E
authors.lastname: Walsh
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdolell
authors.forename: Marian B
authors.initials: MB
authors.lastname: Macken
mesh_terms: D003404:Creatinine / Q000097:blood; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007676:Kidney Failure, Chronic / Q000209:etiology; D011247:Pregnancy; D011379:Prognosis; D016216:Ultrasonography, Prenatal; D014521:Urethra / Q000002:abnormalities* / Q000000981:diagnostic imaging; D014551:Urinary Tract / Q000000981:diagnostic imaging
chemical_list: D003404:Creatinine