PC1119: Association Between Vesicoureteral Reflux and Renal Failure Among Neonatally Managed Patients with Posterior Urethral Valves

Background: Posterior urethral valves (PUV) is one of the most common causes of renal failure in boys. Various predictive markers have been proposed to prognosticate clinical disease including vesicoureteral value (VUR) status. However, previous studies have been limited by heterogenous patient cohorts that have led to varied and sometimes conflicting results. As most diagnoses of PUV are made within the first 30 days of life, we aimed to evaluate the prognostic utility of VUR status in patients with PUV in this homogenous population.

Methods: A single center retrospective review was completed of all patients with PUV diagnosed and managed within 30 days of life from 2010-2019. Previously described risk factors for renal deterioration in this population including VUR status, and nadir creatinine was evaluated. Logistic regression analyses were utilized to assess the associations between VUR presence, nadir creatinine(Cr), and chronic kidney disease(CKD).

Results: A total of 40 patients were identified. The mean age of diagnosis was 6.1days (±7.3), while the mean age of valve resection was 11.2days(±9.5). A total of 23 patients(58%) had concurrent diagnosis of VUR. Median length of follow-up 48(IQR: 24.7-78.9) and 39(IQR:9.5-60.5) months in the VUR and no VUR group respectively. The risk of developing CKD was 14.6x greater among patients with VUR (95% CI:2.5-84.8; p=0.003) compared to patients without VUR. The risk of developing a single of episode of UTI within 2 years of diagnosis was significantly higher in the patients with VUR than those without (58.8% versus 21.7%; p=0.02). No patients had anti-reflux surgery for VUR. Nadir Cr was significantly higher in patients with VUR (0.66mg/dl) than patients without VUR (0.41mg/dl; p=0.05). No patients with a nadir Cr less than 0.8mg/dl progressed to end-stage renal disease.

Conclusion: Using a homogenous population, the presence of VUR in our cohort was predictive of progression to CKD contrary to previous literature.