Predicting and Modifying Risk for Development of Renal Failure in Boys with Posterior Urethral Valves
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Purpose of Review
The purpose of this review is to bring the reader up to date on the current risk factors for the development of renal deterioration in the boys with posterior urethral valves (PUV) and approaches to modify this risk.
Renal bladder ultrasound (RBUS) is routinely performed in boys with PUV and recent advancements allow imaging processing that can more accurately quantify renal parenchyma and correlate this with risk for renal loss. Refinement of urine studies may improve our ability to stratify patients into renal loss categories. Use of videourodynamics (VUDS) allows refined assessment of the valve bladder to identify those who might benefit from secondary procedures and/or the addition of targeted pharmacotherapy to improve bladder emptying or dangerous storage pressures.
All boys with a history of PUV are at a significant long-term risk of renal deterioration. The literature suggests that several technical advances have improved our ability to predict this risk, although there needs to be further refinement and validation before widespread use. Utilization of close follow-up, VUDS, pharmacotherapy, and bladder drainage provide the best methods to improve care to this group of patients and if more studies confirm their utility, adoption of these as part of standard of care protocols may be warranted.
KeywordsPosterior urethral valves Renal insufficiency Anticholinergic Ultrasound
Posterior urethral valves
Lower urinary tract obstruction
Renal bladder ultrasound
Renal parenchymal area
End-stage renal disease
Chronic kidney disease
Compliance with Ethical Standards
Conflict of Interest
Christopher J. Long and Diana K. Bowen each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 22.•• Sarhan OM, El-Ghoneimi AA, Helmy TE, Dawaba MS, Ghali AM, el HI I. Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol. 2011;185(6 Suppl):2491–5. This multivariate analysis highlights many of the possible etiologies of renal loss in PUV. CrossRefPubMedGoogle Scholar
- 30.do Nascimento JH, Soder RB, Epifanio M, Baldisserotto M. Accuracy of computer-aided ultrasound as compared with magnetic resonance imaging in the evaluation of nonalcoholic fatty liver disease in obese and eutrophic adolescents. Radiol Bras. 2015;48(4):225–32.CrossRefPubMedPubMedCentralGoogle Scholar
- 32.•• Odeh R, Noone D, Bowlin PR, Braga LH, Lorenzo AJ. Predicting risk of chronic kidney disease in infants and young children at diagnosis of posterior urethral valves: initial ultrasound kidney characteristics and validation of parenchymal area as forecasters of renal reserve. J Urol. 2016;196(3):862–8. This group describes their experience with readily available technology to improve diagnostic prognosis of RBUS in boys with PUV. CrossRefPubMedGoogle Scholar
- 46.Bajpai M, Chaturvedi PK, Bal CS, Sharma MC, Kalaivani M. Posterior urethral valves: persistent renin angiotensin system activation after valve ablation and role of pre-emptive therapy with angiotensin converting enzyme-inhibitors on renal recovery. J Indian Assoc Pediatr Surg. 2013;18(2):74–8.CrossRefPubMedPubMedCentralGoogle Scholar