Augmentation ileocystoplasty in pediatric population with borderline kidney function(CKD stageIII) / Mohammed Abdou Abdelghany Said ; Supervised Hani Abdelraouf Morsi , Mohamed Nabil Alghoneimy , Waleed Elsayed Ghoneima

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Urology

Objective: To study the impact of the baseline renal function on the outcome of AC in children with normal renal function and those children with various degrees of renal function impairment and to try to determine a safe cut-off value of baseline renal function for augmentation ileocystoplasty in pediatric age-group. Materials and methods: This is a prospective study on 75 children aged from 2 to 14 years old with refractory bladder dysfunction indicated for AC with baseline GFR >30 ml/min for whom augmentation ileocystoplasty were performed between Aug. 2018 and Aug. 2020. GFR was assessed before AC and at 6 to 12 months post AC. Renal function deterioration was defined as progression to a lower CKD stage. Remaining stationary at the same CKD stage or moving to a better stage was considered improvement. Results: 75 children (39 males and 36 females) with a median age of 6 years (range 2- 14) and a baseline GFR > 30 ml/min with refractory bladder dysfunction were included in this prospective study .GFR improved in 53 children (74.6%) and deteriorated in 18 children (25.4%) .Most of children who had low pre AC GFR (80% of CKD stage IIIa and 100% of CKD stage IIIb ) had improved renal function after AC (P= 0.033 and 0.01) .Children with a higher pre AC GFR (CKD stages I and II ) who had lower rates of post AC renal function improvement (55% in CKD stage I and 73.9 % in CKD stage II) (P= 0.008 and 0.168) . Most of children with deteriorated post AC renal function (83.3%) had Higher pre AC GFR (CKD stages I and II). The minimum pre AC GFR in the improvement group was 30 ml/min. There was no statistically significant difference in post operative complications rate at different times of follow up (immediate post operative, post 3 months and post 6-12 months) between each CKD stage apart from metabolic acidosis rate (higher in CKD II (P=0.009)) and hyperchloremia (Higher in CKD IIIb (P=0.018)). AC led to significant symptomatic improvement , significant decrease in febrile UTIs, significant improvement of upper urinary tract dilatation and significant improvement of Urodynamics study parameters. Conclusion : Augmentation ileocystoplasty didn{u2019}t lead (on short term follow up) to further renal function impairment in patients with CKD stage III as was previously assumed . Augmentation ileocystoplasty may be considered safe in pediatric population with GFR as low as 30 ml/min

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