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- Title
A clinical predictive model of chronic kidney disease in children with posterior urethral valves.
- Authors
Vasconcelos, Mariana A.; e Silva, Ana Cristina Simões; Gomes, Izabella R.; Carvalho, Rafaela A.; Pinheiro, Sergio V.; Colosimo, Enrico A.; Yorgin, Peter; Mak, Robert H.; Oliveira, Eduardo A.
- Abstract
Background: Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs.Methods: In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables.Results: Mean follow-up time was 83 months (SD, 70 months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10 years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome.Conclusion: The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.
- Subjects
URETHRA abnormalities; BLADDER; CHRONIC kidney failure; CREATININE; HYPERTENSION; LONGITUDINAL method; PROTEINURIA; REGRESSION analysis; SURVIVAL; PROPORTIONAL hazards models; RETROSPECTIVE studies; DISEASE progression; TERTIARY care; CHILDREN; DIAGNOSIS; DISEASE risk factors
- Publication
Pediatric Nephrology, 2019, Vol 34, Issue 2, p283
- ISSN
0931-041X
- Publication type
Article
- DOI
10.1007/s00467-018-4078-0