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Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management
Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder d...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9405968/ https://www.ncbi.nlm.nih.gov/pubmed/36009441 http://dx.doi.org/10.3390/biomedicines10081894 |
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author | Klaus, Richard Lange-Sperandio, Bärbel |
author_facet | Klaus, Richard Lange-Sperandio, Bärbel |
author_sort | Klaus, Richard |
collection | PubMed |
description | Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dL implies a very low risk for ESKD, whereas a value above 0.85 mg/dL indicates a high risk for ESKD. In addition, bladder dysfunction and renal dysplasia point towards an unbeneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival. |
format | Online Article Text |
id | pubmed-9405968 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-94059682022-08-26 Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management Klaus, Richard Lange-Sperandio, Bärbel Biomedicines Review Posterior urethral valves (PUV) are the most common form of lower urinary tract obstructions (LUTO). The valves can be surgically corrected postnatally; however, the impairment of kidney and bladder development is irreversible and has lifelong implications. Chronic kidney disease (CKD) and bladder dysfunction are frequent problems. Approximately 20% of PUV patients will reach end-stage kidney disease (ESKD). The subvesical obstruction in PUV leads to muscular hypertrophy and fibrotic remodelling in the bladder, which both impair its function. Kidney development is disturbed and results in dysplasia, hypoplasia, inflammation and renal fibrosis, which are hallmarks of CKD. The prognoses of PUV patients are based on prenatal and postnatal parameters. Prenatal parameters include signs of renal hypodysplasia in the analysis of fetal urine. Postnatally, the most robust predictor of PUV is the nadir serum creatinine after valve ablation. A value that is below 0.4 mg/dL implies a very low risk for ESKD, whereas a value above 0.85 mg/dL indicates a high risk for ESKD. In addition, bladder dysfunction and renal dysplasia point towards an unbeneficial kidney outcome. Experimental urinary markers such as MCP-1 and TGF-β, as well as microalbuminuria, indicate progression to CKD. Until now, prenatal intervention may improve survival but yields no renal benefit. The management of PUV patients includes control of bladder dysfunction and CKD treatment to slow down progression by controlling hypertension, proteinuria and infections. In kidney transplantation, aggressive bladder management is essential to ensure optimal graft survival. MDPI 2022-08-05 /pmc/articles/PMC9405968/ /pubmed/36009441 http://dx.doi.org/10.3390/biomedicines10081894 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Klaus, Richard Lange-Sperandio, Bärbel Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management |
title | Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management |
title_full | Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management |
title_fullStr | Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management |
title_full_unstemmed | Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management |
title_short | Chronic Kidney Disease in Boys with Posterior Urethral Valves–Pathogenesis, Prognosis and Management |
title_sort | chronic kidney disease in boys with posterior urethral valves–pathogenesis, prognosis and management |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9405968/ https://www.ncbi.nlm.nih.gov/pubmed/36009441 http://dx.doi.org/10.3390/biomedicines10081894 |
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