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Review
. 2023 Mar 15:11:1085143.
doi: 10.3389/fped.2023.1085143. eCollection 2023.

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis

Davide Meneghesso  1 , Nicola Bertazza Partigiani  1 , Rachele Spagnol  1 , Alessandra Rosalba Brazzale  2 , Alessandro Morlacco  3 , Enrico Vidal  1   4
Affiliations
Review

Nadir creatinine as a predictor of renal outcomes in PUVs: A systematic review and meta-analysis

Davide Meneghesso et al. Front Pediatr. .

Abstract

Background: Posterior urethral valves (PUVs) represent the most severe pediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%-21% of patients. Unfortunately, renal outcomes have poorly improved over time. The key point is to identify patients at risk; thus, several prenatal and postnatal prognostic factors have been analyzed to improve clinical outcomes. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding.

Objective: We performed a systematic review with meta-analysis to analyze the predictive value of nadir creatinine on long-term renal function in infants with PUVs.

Methods: We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps.

Results: A total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analyzed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35-25.17, I 2 = 92.20%, p < 0.001).

Conclusions: Nadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.

Keywords: chronic kidney disease; nadir creatinine; posterior urethral valve (PUV); posterior urethral valves; predictive factor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study selection process.
Figure 2
Figure 2
Forest plot for meta-analysis and meta-regression, accounting for the type of effect measure for the relative risk of developing CKD in patients with VUPs. CKD, chronic kidney disease; VUR, vesico-ureteral reflux.
Figure 3
Figure 3
Funnel plot for meta-analysis and meta-regression, accounting for the type of effect measure, for the relative risk of developing CKD in patients with VUPs. CKD, chronic kidney disease.
See this image and copyright information in PMC

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