Tags

Type your tag names separated by a space and hit enter

Posterior urethral valves: Metabolic consequences in a cohort of patients.
J Pediatr Urol. 2015 Aug; 11(4):216.e1-6.JP

Abstract

BACKGROUND

Despite the improvements in diagnosis and management of posterior urethral valves (PUVs), about one third of patients develop chronic kidney disease (CKD). Children with PUVs might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels, which could affect their bone growth and overall health.

OBJECTIVE

The aim was to determine the relationship between kidney function, vitamin D deficiency and secondary hyperparathyroidism in children with PUVs.

PATIENTS AND METHODS

Sixty-four children with PUVs were followed for a period of 3.64 ± 2.50 years after their initial presentation and management. Their laboratory parameters were compared with 20 age-, gender- and race-matched children in a control group, including: serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D levels, and kidney function.

RESULTS

Children with PUVs had significantly lower estimated kidney function (P = 0.006) and vitamin D levels (P < 0.001) and higher iPTH levels (P = 0.042). There were no significant between-group differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, and bicarbonate levels. There was a strong correlation between the degree of vitamin D deficiency and hyperparathyroidism and the degree of kidney dysfunction (r = 0.52 and -0.52, respectively) in the PUV group. On a multivariate analysis, the kidney dysfunction was the only independent predictor of vitamin D deficiency (ρ = 0.271, P < 0.001), while kidney dysfunction, serum calcium and alkaline phosphatase were independent predictors for hyperparathyroidism (ρ = 0.925, P<0.001, ρ = 0.933, P<0.001 and ρ = 0.913, P < 0.001, respectively).

DISCUSSION

The prevalence of CKD in children with PUVs ranges from 30 to 60%. Patients with CKD are more likely to have vitamin D deficiency and display more-prominent hyperparathyroidism. Compared with a control group with normal kidney function, the present cohort had lower 25-hydroxyvitamin D and higher iPTH serum levels. Abnormal kidney function was a major predictor for both serum levels. In this cohort, there were no significant differences in serum calcium and phosphorus between children with PUVs and the control group, and also between those with and without CKD. On the contrary, vitamin D level decreased early in the disease and progressively declined thereafter, while iPTH was the opposite. These findings were comparable to previous studies. This study had some limitations because it was a single center cross-sectional non-randomized study. However, the findings in this study can be extrapolated to children with PUVs and CKD from other origins because the unit is considered as a referral center in the Middle East region.

CONCLUSION

Abnormal kidney function, vitamin D deficiency, and secondary hyperparathyroidism are prevalent in children with PUVs. Kidney function is the main determinant of vitamin D and parathyroid hormone levels. Efforts should be directed toward managing CKD, and controlling vitamin D deficiency and hyperparathyroidism in children after ablation of PUV.

Authors+Show Affiliations

Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; Urology and Nephrology Center, Mansoura University, Mansoura, Egypt. Electronic address: o_sarhan2004@yahoo.com.Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address: drziad@hotmail.com.Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address: alghanbar@yahoo.com.Division of Pediatric Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Electronic address: alotay99@hotmail.com.Biochemistry Department, Mansoura University, Mansoura, Egypt. Electronic address: emyosh@yahoo.com.Division of Nephrology, University of Kentucky, Lexington, KY, USA. Electronic address: charlesmwhitehead@gmail.com.Urology and Nephrology Center, Mansoura University, Mansoura, Egypt; Division of Nephrology, University of Kentucky, Lexington, KY, USA. Electronic address: amr.elhusseini.moh@uky.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26096436

Citation

Sarhan, O, et al. "Posterior Urethral Valves: Metabolic Consequences in a Cohort of Patients." Journal of Pediatric Urology, vol. 11, no. 4, 2015, pp. 216.e1-6.
Sarhan O, Nakshabandi Z, Alghanbar M, et al. Posterior urethral valves: Metabolic consequences in a cohort of patients. J Pediatr Urol. 2015;11(4):216.e1-6.
Sarhan, O., Nakshabandi, Z., Alghanbar, M., Alotay, A., Sherif, I., Whitehead, C., & El-Husseini, A. (2015). Posterior urethral valves: Metabolic consequences in a cohort of patients. Journal of Pediatric Urology, 11(4), e1-6. https://doi.org/10.1016/j.jpurol.2015.04.022
Sarhan O, et al. Posterior Urethral Valves: Metabolic Consequences in a Cohort of Patients. J Pediatr Urol. 2015;11(4):216.e1-6. PubMed PMID: 26096436.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior urethral valves: Metabolic consequences in a cohort of patients. AU - Sarhan,O, AU - Nakshabandi,Z, AU - Alghanbar,M, AU - Alotay,A, AU - Sherif,I, AU - Whitehead,C, AU - El-Husseini,A, Y1 - 2015/06/04/ PY - 2014/12/30/received PY - 2015/04/22/accepted PY - 2015/6/23/entrez PY - 2015/6/23/pubmed PY - 2016/5/18/medline KW - Children KW - Chronic kidney disease-mineral bone disorder KW - Posterior urethral valves KW - Secondary hyperparathyroidism KW - Vitamin D deficiency SP - 216.e1 EP - 6 JF - Journal of pediatric urology JO - J Pediatr Urol VL - 11 IS - 4 N2 - BACKGROUND: Despite the improvements in diagnosis and management of posterior urethral valves (PUVs), about one third of patients develop chronic kidney disease (CKD). Children with PUVs might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels, which could affect their bone growth and overall health. OBJECTIVE: The aim was to determine the relationship between kidney function, vitamin D deficiency and secondary hyperparathyroidism in children with PUVs. PATIENTS AND METHODS: Sixty-four children with PUVs were followed for a period of 3.64 ± 2.50 years after their initial presentation and management. Their laboratory parameters were compared with 20 age-, gender- and race-matched children in a control group, including: serum calcium, phosphorus, intact parathyroid hormone (iPTH), 25-hydroxyvitamin D levels, and kidney function. RESULTS: Children with PUVs had significantly lower estimated kidney function (P = 0.006) and vitamin D levels (P < 0.001) and higher iPTH levels (P = 0.042). There were no significant between-group differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, and bicarbonate levels. There was a strong correlation between the degree of vitamin D deficiency and hyperparathyroidism and the degree of kidney dysfunction (r = 0.52 and -0.52, respectively) in the PUV group. On a multivariate analysis, the kidney dysfunction was the only independent predictor of vitamin D deficiency (ρ = 0.271, P < 0.001), while kidney dysfunction, serum calcium and alkaline phosphatase were independent predictors for hyperparathyroidism (ρ = 0.925, P<0.001, ρ = 0.933, P<0.001 and ρ = 0.913, P < 0.001, respectively). DISCUSSION: The prevalence of CKD in children with PUVs ranges from 30 to 60%. Patients with CKD are more likely to have vitamin D deficiency and display more-prominent hyperparathyroidism. Compared with a control group with normal kidney function, the present cohort had lower 25-hydroxyvitamin D and higher iPTH serum levels. Abnormal kidney function was a major predictor for both serum levels. In this cohort, there were no significant differences in serum calcium and phosphorus between children with PUVs and the control group, and also between those with and without CKD. On the contrary, vitamin D level decreased early in the disease and progressively declined thereafter, while iPTH was the opposite. These findings were comparable to previous studies. This study had some limitations because it was a single center cross-sectional non-randomized study. However, the findings in this study can be extrapolated to children with PUVs and CKD from other origins because the unit is considered as a referral center in the Middle East region. CONCLUSION: Abnormal kidney function, vitamin D deficiency, and secondary hyperparathyroidism are prevalent in children with PUVs. Kidney function is the main determinant of vitamin D and parathyroid hormone levels. Efforts should be directed toward managing CKD, and controlling vitamin D deficiency and hyperparathyroidism in children after ablation of PUV. SN - 1873-4898 UR - https://www.unboundmedicine.com/medline/citation/26096436/Posterior_urethral_valves:_Metabolic_consequences_in_a_cohort_of_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1477-5131(15)00189-8 DB - PRIME DP - Unbound Medicine ER -