RESUMEN
BACKGROUND: Posterior urethral valves (PUV) account for 17% of paediatric end-stage renal disease. A major issue in the management of PUV is prenatal prediction of postnatal renal function. Fetal ultrasound and fetal urine biochemistry are currently employed for this prediction, but clearly lack precision. We previously developed a fetal urine peptide signature that predicted in utero with high precision postnatal renal function in fetuses with PUV. We describe here the objectives and design of the prospective international multicentre ANTENATAL (multicentre validation of a fetal urine peptidome-based classifier to predict postnatal renal function in posterior urethral valves) study, set up to validate this fetal urine peptide signature. METHODS: Participants will be PUV pregnancies enrolled from 2017 to 2021 and followed up until 2023 in >30 European centres endorsed and supported by European reference networks for rare urological disorders (ERN eUROGEN) and rare kidney diseases (ERN ERKNet). The endpoint will be renal/patient survival at 2 years postnatally. Assuming α = 0.05, 1-ß = 0.8 and a mean prevalence of severe renal outcome in PUV individuals of 0.35, 400 patients need to be enrolled to validate the previously reported sensitivity and specificity of the peptide signature. RESULTS: In this largest multicentre study of antenatally detected PUV, we anticipate bringing a novel tool to the clinic. Based on urinary peptides and potentially amended in the future with additional omics traits, this tool will be able to precisely quantify postnatal renal survival in PUV pregnancies. The main limitation of the employed approach is the need for specialized equipment. CONCLUSIONS: Accurate risk assessment in the prenatal period should strongly improve the management of fetuses with PUV.
RESUMEN
INTRODUCTION: Most children with cancer have a tunnelled central venous catheter (CVC) inserted. The optimal type of CVC for children of all ages has not been identified. The purpose of this paper was to analyze factors correlated to the duration of catheterization of the first inserted CVC in children with cancer. MATERIALS AND METHODS: All children with cancer who had their first CVC inserted between 01-01-2000 and 01-09-2006. Retrospective and prospective study of medical charts with respect to the type of CVC, age of the child at insertion, dates of insertion and removal, diagnosis and cause of CVC removal. RESULTS: Between 01-01-2000 and 01-09-2006 155 double lumen Hickmans (2-Hick) and 86 double lumen Port-a-Caths (2-PaC) were inserted. The total number of CVC days was 27,192 for 2-Hicks and 20,623 for 2-PaCs. The median duration of catherization was significantly longer for 2-PaCs compared with 2-Hicks (200 versus 135 days). Compared with 2-PaCs significantly more 2-Hicks were removed non-electively because of either infections or mechanical complications. The survival of 2-Hicks was significantly shorter in children <5 years of age, but for 2-PaCs there were no correlation between the duration of catherization and the age of the child. 67% of the 2-PaCs were removed at the end of treatment compared with 32% of the 2-Hicks (P< 0,001, chi2 test). A multivariate analysis showed that the type of CVC (P<0,001) and the age of the child (P< 0,001) were independent factors for the duration of the catheterization. CONCLUSION: Port-a-Caths for children of all ages with cancer are associated with significantly fewer catheter removals due to complications.