title: Predictive Factors of Chronic Kidney Disease in Patients with Vesicoureteral Reflux Treated Surgically and Followed after Puberty.
abstract: OBJECTIVE
  We delineated clinical features and determined predictors of chronic kidney disease during long-term postpubertal followup in patients with vesicoureteral reflux treated surgically.
  
  
  METHODS
  We analyzed the data of 101 patients who were surgically treated for vesicoureteral reflux and had gone through puberty. Patients underwent preoperative and postoperative voiding cystourethrography to assess reflux status, and dimercaptosuccinic acid scan to assess renal cortical defects. We compared several variables preoperatively and postpubertally, including body mass index; blood urea nitrogen, creatinine and uric acid levels; estimated glomerular filtration rate; microalbuminuria; blood pressure; renal function and renal scarring. Kaplan-Meier analysis was used to predict chronic kidney disease-free survival rates throughout the followup periods. Cox regression model was adopted to identify independent predictors of chronic kidney disease. We defined chronic kidney disease as estimated glomerular filtration rate less than 60 ml/minute/1.73 m(2).
  
  
  RESULTS
  Median followup was 100.0 months (IQR 69.0 to 136.5). Median age was 16 years at last followup (IQR 14 to 18). A total of 11 patients (10.9%) were diagnosed with de novo chronic kidney disease during postpubertal followup. It is noteworthy that serum uric acid levels (HR 1.96) and presence of high grade reflux (HR 7.40) were significant predictors of chronic kidney disease on multivariate analysis.
  
  
  CONCLUSIONS
  In children who were treated surgically for vesicoureteral reflux preoperative uric acid levels and high grade reflux were independent predictors of de novo chronic kidney disease during postpubertal followup. Our results offer valuable information for predicting long-term renal outcomes in patients with vesicoureteral reflux treated surgically.
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Minyong
authors.initials: M
authors.lastname: Kang
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Jung Keun
authors.initials: JK
authors.lastname: Lee
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Young Jae
authors.initials: YJ
authors.lastname: Im
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Korea.
authors.forename: Hwang
authors.initials: H
authors.lastname: Choi
authors.affiliation: Department of Urology, College of Medicine, Seoul National University, Seoul, Korea. Electronic address: urodori@naver.com.
authors.forename: Kwanjin
authors.initials: K
authors.lastname: Park
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011379:Prognosis; D011627:Puberty; D051436:Renal Insufficiency, Chronic / Q000453:epidemiology / Q000209:etiology*; D018570:Risk Assessment; D013997:Time Factors; D014718:Vesico-Ureteral Reflux / Q000150:complications* / Q000601:surgery*
keywords: adolescent; prognosis; renal insufficiency, chronic; surgical procedures, operative; vesico-ureteral reflux