Can baseline serum creatinine and e-GFR predict renal function outcome after augmentation cystoplasty in children?

Vol. 43 (x): 2017 June 6.[Ahead of print]

doi: 10.1590/S1677-5538.IBJU.2017.0078


ORIGINAL ARTICLE

Prempal Singh 1, Ankur Bansal 1, Virender Sekhon 1, Sandeep Nunia 1, M. S. Ansari 1
1  Department of Urology and Renal Transplant, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

ABSTRACT

Objective: To assess cut-off value of creatinine and glomerular filtration rate for aug­mentation cystoplasty (AC) in paediatric age-group.

Materials and Methods: Data of all paediatric-patients (<18 years) with small capac­ity bladder, in whom AC was advised between 2005-2015 were reviewed. All patients were divided in two-groups, AC-group and control-group (without AC). Creatinine and e-GFR were assessed at the time of surgery, at 6 months and at last follow-up. Renal function deterioration was defined as increase in creatinine by ≥25% from baseline value or new-onset stage-3 CKD or worsening of CKD stage with pre-operative-CKD stage-3. ROCs were plotted using creatinine and e-GFR for AC.

Results: A total of 94 patients with mean-age 8.9 years were included. The mean cre­atinine and e-GFR were 1.33mg/dL and 57.68mL/min respectively. Out of 94 patients, AC was performed in 45 patients and in the remaining 49 patients AC was not done (control-group), as they were not willing for the same. Baseline patient’s characteris­tics were comparable in both Groups. 22 underwent gastro-cystoplasty (GC) and 25 underwent ileo-cystoplasty (IC). Decline in renal function was observed in 15 (33.3%) patients of AC-group and in 31 (63.3%) patients of control-group. Patients having creatinine ≥1.54mg/dL (P=0.004, sensitivity (S) 63.6% and specificity (s) 90.5%) at baseline and e-GFR <46mL/min (P=0.000, S=100% and s=85.7%) at the time of surgery had significantly increased probability of renal function deterioration on follow-up after AC.

Conclusion: e-GFR <46mL/min and creatinine ≥1.54mg/dL at time of surgery could serve as a predictor of renal function deterioration in AC in paediatric patients.

Keywords: Serum; Delayed Graft Function; Creatinine

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