Abstract: SA-OR046

Survival and Morbidity of Children with Posterior Ureteral Valves

Session Information

Category: Developmental Biology and Inherited Kidney Diseases

  • 403 Pediatric Nephrology

Authors

  • Lockwood, Gina, Connecticut Children's Medical Center, Hartford, Connecticut, United States
  • Herbst, Katherine W., Connecticut Children's Medical Center, Hartford, Connecticut, United States
  • D'Alessandri-Silva, Cynthia J., Connecticut Children's Medical Center, Hartford, Connecticut, United States
Background

Posterior urethral valves (PUV) is a severe urologic condition causing a spectrum of sequelae. PUV can lead to end-stage renal disease, dialysis, renal transplantation, and premature death. Predicting outcomes is challenging as prognostic measures remain imprecise. We aimed to describe outcomes for children with PUV in United States children’s hospitals.

Methods

The Pediatric Health Information System (PHIS) database was searched for children diagnosed with PUV (ICD-9 code 753.6; congenital urethral stenosis) with initial hospitalization between 1992 and 2006 in their first year of life. Valve ablation or mortality following urinary drain placement was used to confirm diagnosis of PUV. Primary outcomes of dialysis catheter placement, renal transplant and mortality were determined by disposition and ICD-9/ICD-10 codes found in subsequent hospitalizations through 12/31/2016. Dialysis catheter insertion was used as a proxy for dialysis treatments, as these are not generally captured in the PHIS dataset. Subjects from hospitals without a transplant program were excluded from transplant analysis.

Results

Our cohort included 754 males with median age upon hospitalization of 7 days (IQR 1-38 days). Over 90% were discharged at one month of age or less. The majority (621; 82%) did not experience any of the outcomes described, and 232 (37%) did not have a subsequent PHIS hospitalization. Of 60 (7.9%) subjects who underwent dialysis catheter placement, 34 (57%) did so during their initial hospitalization. Only 10 (16.7%) underwent placement at >5 years. Thirty-six (6.5%) subjects underwent renal transplant at a median age of 3.2 years (IQR 2.0-8.1 years), with 26 (43%) of those who underwent dialysis catheter placement undergoing transplantation. Twelve (33%) subjects underwent transplant after five years of age. Of 33 (4.4%) patients who died, 32 (97%) did so at <5 years, with 19 (58%) expiring during their initial hospitalization.

Conclusion

Relatively small but significant proportions of children with PUV at PHIS hospitals undergo dialysis, renal transplantation and/or premature death. Most outcomes occur at <5 years of age, as expected in those born with severe nephropathy. As risk factors for renal deterioration are studied, these statistics from a large cohort can help to counsel parents and guide physician management.

Funding

  • Clinical Revenue Support