Evidence map›Paper›PMID 40560270›Full record

ArticlePediatric nephrology (Berlin, Germany)2025

Impact of a standardized care pathway and a dedicated multidisciplinary posterior urethral valve clinic on 5-year kidney and bladder outcomes.

Mandy Rickard, Armando J Lorenzo, Cal Robinson, Samer Maher, Jin Kyu Kim, Adree Khondker, Mirriam Mikhail, Beverly Miranda, Rodrigo Romao, Joao Pippi Salle and 4 more

Abstract read
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In one paragraph

Article in Pediatric nephrology (Berlin, Germany), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Mandy RickardDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada. Mandy.rickard@sickkids.ca.ORCID 0000-0003-0598-1824
Armando J LorenzoDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Cal RobinsonDepartment of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Samer MaherDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Jin Kyu KimDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Adree KhondkerDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Mirriam MikhailDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Beverly MirandaDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Rodrigo RomaoDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Joao Pippi SalleDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Michael ChuaDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.
Aseel Al-DmourDepartment of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Nithiakishna SelvathesanDepartment of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada.
Joana Dos SantosDivision of Urology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G1X8, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPosterior urethral valves (PUV) are a rare congenital condition leading to chronic kidney disease (CKD) and bladder dysfunction. Traditional management is often reactive and non-standardized. In 2019, we implemented a dedicated multidisciplinary PUV clinic with a standardized, proactive management pathway to optimize kidney and bladder outcomes. This study evaluates its impact over 5 years.

methodsWe conducted a retrospective review of our prospectively maintained PUV database, including patients diagnosed before 24 months and managed exclusively at our institution. Outcomes were compared between patients managed in the PUV clinic (aPUV) to patients before implementation (bPUV). Primary outcomes included kidney function (serum creatinine, eGFR, CKD progression, and kidney replacement therapy). Secondary outcomes assessed bladder function, including medications, catheterization, and urinary tract infections.

resultsA total of 196 patients were analyzed (bPUV: 133; aPUV: 63). The aPUV cohort had earlier interventions and a higher rate of primary urinary diversion (54% vs. 11%; p < 0.01). The aPUV group had lower nadir serum creatinine (21 vs. 29 μmol/l; p < 0.01), reduced CKD progression (12% vs. 27%; p = 0.02), and fewer patients requiring kidney replacement therapy (3% vs. 20%; p < 0.01). Earlier bladder therapy initiation led to reduced hydronephrosis and timelier catheterization.

conclusionA standardized PUV clinic and proactive management approach significantly improved kidney and bladder outcomes at 5 years. If sustained, this strategy may delay CKD progression and reduce the need for kidney replacement therapy. Longer follow-up is needed to assess long-term impact.

Indexed as

Critical PathwaysRenal Insufficiency, ChronicUrethraUrinary Bladder DiseasesAdolescentChildChild, PreschoolDisease ProgressionFemaleGlomerular Filtration RateHumansInfantMalePatient Care TeamRenal Replacement TherapyRetrospective StudiesClinical pathwayCongenital uropathyKidney function outcomesPosterior urethral valves

Identifiers

PMID40560270

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.