title: Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome.
abstract: OBJECTIVE
  Posterior urethral valves represent the most common obstructive uropathy in children with a broad spectrum of clinical severity. We evaluated prognostic variables affecting the outcome of renal function in such children.
  
  
  METHODS
  Between 1987 and 2004, 120 patients with a mean age of 2 years with posterior urethral valves were treated initially with valve ablation at our center. We studied certain parameters, including age at presentation, serum creatinine (initial and nadir), initial creatinine clearance, renal ultrasound findings (hydronephrosis and renal parenchymal echogenicity), vesicoureteral reflux on initial voiding cystourethrogram, bladder dysfunction and popoff mechanisms such as the syndrome of large vesical diverticulum, urinoma and ascites. Long-term renal outcome was assessed.
  
  
  RESULTS
  Followup was 2 to 16 years (median 3.6). Renal insufficiency developed at the end of followup in 44 patients (36.5%). Serum creatinine at hospital admission, nadir serum creatinine, initial creatinine clearance and renal parenchymal echogenicity were significant predictors of the final renal outcome (p < 0.05). Patient age at diagnosis (2 or less vs greater than 2 years), upper tract dilatation, the presence or absence of vesicoureteral reflux, popoff mechanisms and bladder dysfunction had no significant impact on future renal function. On 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, initial serum creatinine, creatinine clearance and renal parenchymal echogenicity on initial renal ultrasound correlate significantly with long-term renal function in children with posterior urethral valves.
authors.affiliation: Urology and Nephrology Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt. o_sarhan2004@yahoo.com
authors.forename: Osama M
authors.initials: OM
authors.lastname: Sarhan
authors.forename: Alaa A
authors.initials: AA
authors.lastname: El-Ghoneimi
authors.forename: Tamer E
authors.initials: TE
authors.lastname: Helmy
authors.forename: Mohamed S
authors.initials: MS
authors.lastname: Dawaba
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Ghali
authors.forename: El-Houssiny I
authors.initials: el-HI
authors.lastname: Ibrahiem
mesh_terms: D002675:Child, Preschool; D003404:Creatinine / Q000097:blood; D006801:Humans; D007677:Kidney Function Tests; D008297:Male; D015999:Multivariate Analysis; D016896:Treatment Outcome; D014521:Urethra / Q000002:abnormalities* / Q000601:surgery*
chemical_list: D003404:Creatinine