Prognostic factors in Saudi children with posterior urethral valves

Posterior urethral valves (PUV) account for a sizeable proportion of children with chronic renal failure. Several criteria have been identified as predictive of future renal function in children with PUV. We compared the presenting features and initial treatment in two groups of Saudi children treated for PUV, with the aim of identifying any factors that might account for the differences observed in their renal function. One group (group A, 19 patients) had a serum creatinine of 80 micromol/l or less at follow-up and the other (group B, 13 patients) had higher levels. There was no significant difference in age or weight at presentation, incidence and severity of reflux, urinary tract infection, or type of primary treatment (valve ablation versus vesicostomy) between the two groups. However, after 5-7 days of catheter drainage, the mean serum creatinine level was 88+/-62 micromol/l for patients in group A compared with 172+/-77 micromol/l for those in group B (P<0.0001). This difference was highly significant. Linear regression analysis of post-drainage creatinine and serum creatinine at last follow-up showed a correlation coefficient of 0.7171 (P<0.0001). Hence the serum creatinine level after catheter drainage correlated strongly with renal function during short-term follow-up of Saudi children with PUV. This might help in the selection of the optimal initial therapy and provide some basis for prognostication.

Management of uretero-pelvic obstruction in developing countries

Congenital pelvi-ureteric junction (PUJ) was found in 29 of 36 renal units explored for impaired pelvic drainage in 34 adults. There was a primary nephrectomy rate of 8.4%, and follow up was poor. The widespread use of ultrasound scan has led to an increase in the number of children with equivocal PUJ obstruction. Where surveillance is inadequate, as is the case in developing countries, we suggest that early operation might lead to better renal salvage in such cases.