Pop-off mechanisms as renoprotective mediators in children with posterior urethral valves: A systematic review and meta-analysis
Bibliographic record
Abstract
Abstract Background Pop-off mechanisms are potential pressure-relieving mediators in patients diagnosed with posterior urethral valves (PUV). These mechanisms include, among others, urachal persistence, urinomas, bladder diverticula and unilateral high-grade vesicoureteral reflux. The aim of this systematic review was to synthesize the existing evidence regarding the protective effect of pop-off mechanisms on renal function in children with PUV. Methods We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography. Three independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the Newcastle Ottawa Scale index. Data extraction was performed by three independent reviewers. We used random meta-analyses to compare different outcomes (serum creatine, Nadir serum creatinine, and renal failure) between children with PUV and pop-off mechanisms and those with PUV but without pop-off mechanisms. Results 10 studies with data from 896 participants were included in this review. The age of the participants ranged from 0 to 25 years. Seven articles reported serum creatinine values for each group and 3 of them found significant differences between groups. The random-effects meta-analysis for serum creatinine showed significant lower mean (diff=-52.88 µmol/L [95% CI -73.65 to -32.11]) in the group of children with pop-off mechanisms, and the random-effects meta-analysis for Nadir serum creatinine showed a marginally significant lower mean in the group of children with pop-off mechanisms (diff=-12.00 µmol/L [95% CI -24.04 to 0.04]). The random-effect meta-analysis for renal failure resulted in a significant risk reduction on the group of children with pop-off mechanisms (odds ratio = 0.48 [95% CI 0.23 to 0.98]). Conclusions Children with PUV and pop-off mechanisms show better renal function and lower risk of renal failure than those with PUV but without pop-off mechanisms suggesting these mechanisms may act as renoprotective mediums. The high heterogeneity between studies in the assessment of renal function and long-term outcomes compel to interpret these findings with caution. Future studies that stratify by the different types of pop-off mechanisms and use standardized metrics, such as Nadir creatinine are needed.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.026 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.016 | 0.028 |
| Bibliometrics | 0.005 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".