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POSTERIOR URETHRAL VALVES: METABOLIC CONSEQUENCES IN A COHORT OF PATIENTS.
Osama M. Sarhan, MD1, ZIAD M. NAKSHABANDI, MD1, MUSTAFA AL GHANBAR, MD1, ABDULHAKIM AL OTAY, MD1, CHARLES WHITEHEAD, PHD2, AMR EL-HUSSEINI, MD3.
1Prince Sultan Military Medical City, Riyadh, Saudi Arabia, 2Division of Nephrology, University of Kentucky, Kentucky, KY, USA, 3Division of Nephrology, University of Kentucky, KENTUCKY, KY, USA.

BACKGROUND:
Despite the improvement in posterior urethral valves (PUVs) diagnosis and management; about one third of patients progress to renal failure. Children with PUVs might have abnormal calcium, phosphorus, vitamin D and parathyroid hormone levels which could affect their bone health.
METHODS:
We followed a cohort of 64 children with PUVs for a period of 3.64±2.50 years after their initial presentation and management. We compared their laboratory parameters including serum calcium, phosphorus, parathyroid hormone, 25 hydroxy vitamin D levels and kidney function with 20 age, gender and race matched control group.
RESULTS:
Patients with PUVs have a significantly lower estimated kidney function (P = 0.006) and vitamin D levels (P = 0.001) and higher parathyroid hormone levels (P = 0.042) compared to the control group. No significant differences in serum calcium, phosphorus, alkaline phosphatase, sodium, potassium, bicarbonate levels were found between 2 groups. There was a strong correlation with the degree of vitamin D deficiency and hyperparathyroidism with the degree of kidney dysfunction (r 0.52 and -0.52 respectively) in the PUVs 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 function, 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).
CONCLUSIONS:
Abnormal kidney function, vitamin D deficiency and hyperparathyroidism are prevalent after PUVs management. Kidney function is the main determinant of vitamin D level while kidney function, serum calcium and alkaline phosphatase were independent predictors for parathyroid hormone levels. Efforts should be directed toward managing chronic kidney disease and controlling vitamin D deficiency and hyperparathyroidism in children after PUVs ablation.


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