Obstructive uropathy: causes and outcome in pediatric patients

ABSTRACT

To pinpoint the major causes of obstructive uropathy in children and determine the outcome in terms of renal impairment and mortality. This observational study included pediatric patients presenting with obstructive kidney disease. All consecutive pediatric patients [< 12 years] presenting with signs and symptoms of obstructive uropathy +/- chronic kidney disease [CKD] for the duration of 3 months or more represented by a GFR of < 52 ml/min/m were included while patients with co-morbidities representing independent mortality risk like congenital heart diseases and with non-obstructive causes of renal failure and patients with no evidence of urinary tract obstruction on either ultra sonogram or renal scan were excluded. They were categorized into five segments and the outcome of the treatment at the end of follow up period of 2 years was recorded and categorized similarly to eliminate any bias. Forty three patients were recruited initially but 3 were excluded. The mean age was 5.3 years and there were 33 [82.5%] males. Majority had severe growth retardation. Posterior urethral valve [45%] and nephrolithiasis [35%] were commonest causes. The mean serum creatinine on admission was 6.35 [1.2-22] mg/d and at the end of follow up had reduced to 1.6 [0.4-3.2] mg/dl. [p- 0.0017]. Post treatment 27 [67.5%] patients had no residual renal impairment while only 5 patients [12.5%] patients developed ESRD and were referred for transplant. We conclude that obstructive uropathy is an important cause of preventable renal failure in children