Prognostic factors for persistent distal renal tubular acidosis after surgery for posterior urethral valve

Risk factors, including age at presentation, age at surgery, time between p resentation and surgery, urodynamic abnormalities, and vesicoureteric reflu x, were prospectively studied for the development of distal renal tubular a cidosis (DRTA) before surgery and persistent DRTA after surgery in 24 boys with posterior urethral valve (PUV) with normal serum creatinine levels. DR TA was persistent in 11 of 17 boys (65%) at the end of follow-up after inte rvention. For the development of DRTA before surgery, only a longer time be tween presentation and surgery (intervening period) turned out to be a sign ificant risk factor on multivariate analysis (beta = -0.13; P = 0.04). Boys with persistent DRTA after surgery had older age at presentation (P = 0.03 ), older age at surgery (P = 0.001), a longer intervening period (P = 0.000 7), and bilateral or severe unilateral reflux (P = 0.04) before surgery. On univariate logistic regression, age at surgery (beta = -0.07; P = 0.04) an d intervening period (beta = -0.13; P = 0.02) were found to be significant risk factors for persistent DRTA, but on multivariate analysis, only interv ening period was found to be significant (beta = -0.13; P = 0.02). A delay in intervention after noticing voiding symptoms can predict a high incidenc e of DRTA before intervention and persistent DRTA after surgery in boys wit h PUV. (C) 2001 by the National Kidney Foundation, Inc.