He noted hat the fate of the child with chronic renal failure depends on underlying causes of the renal disease and it is difficult to predict the timeline to progression of end-stage renal disease. However factors which may predict progression include: albuminemia, febrile UTIs, hypertension, estimated glomerular filtration rate at onset and at puberty.
Dr. Koyle discussed the diminished primary role of pediatric urologists in multi-organ system transplantation, but did argue that pediatric urologists do play a secondary role – the management of lower urinary tract function and emphasized the importance of establishing whether or not the child has a “good or bad bladder.” The pre-transplant evaluation regarding lower urinary tract function will vary with the etiology of the ESRF. Children with a history of voiding dysfunction, recurrent UTIs and hydronephrosis will need a work-up of the lower urinary tract. Those children with recurrent UTIs, hydronephrosis and/or significant asymmetry in renal size need a VCUG. Urodynamics may be helpful in children with posterior urethral valves, prune belly and neurogenic bladders. Augmentation is more commonly needed in children with neurogenic bladder dysfunction with low capacity, high pressure bladders, and those with high detrusor leak point pressures.
Session moderated by Marty Koyle, MD at the 59th Annual Meeting of the Society for Pediatric Urology during the American Urological Association (AUA) Annual Meeting - May 14 - 19, 2011 - Walter E. Washington Convention Center, Washington, DC USA
Reported for UroToday by Pamela I. Ellsworth, MD, Associate Professor Surgery (Urology), Alpert Medical School of Brown University.
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