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Updated: Feb 5, 2026
Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
A clinical predictive model of chronic kidney disease in children with posterior urethral valves
Mariana A Vasconcelos1, Ana Cristina Simões E Silva1, Izabella R Gomes1
1Pediatric Nephrourology Division, Department of Pediatrics, National Institute of Science and Technology (INCT) of Molecular Medicine, School of Medicine, Federal University of Minas Gerais (UFMG), R. Engenheiro Amaro Lanari 389/501, Belo Horizonte, MG, 30310-580, Brazil.
Insights
Posterior urethral valves (PUVs) can lead to chronic kidney disease (CKD). A new predictive model identifies high-risk patients, enabling timely interventions to preserve kidney function in children with PUVs.
Area of Science:
- Pediatric Nephrology
- Urology
- Clinical Prediction Modeling
Background:
- Posterior urethral valves (PUVs) are a significant cause of urinary tract issues and chronic kidney disease (CKD) in children.
- Early identification of risk factors for CKD in PUV patients is crucial for management.
Purpose of the Study:
- To develop and validate a clinical predictive model for chronic kidney disease (CKD) stage ≥3 in a cohort of patients diagnosed with posterior urethral valves (PUVs).
Main Methods:
- A retrospective cohort study involving 173 patients with PUVs.
- Survival analysis using Cox regression models (time-fixed and time-dependent covariables) to identify predictors of CKD.
- Development of a prognostic risk score categorized into low, medium, and high-risk groups.
Main Results:
- 37.6% of patients developed CKD stage ≥3 during a mean follow-up of 83 months.
- Baseline creatinine, nadir creatinine, hypertension, and proteinuria were identified as key predictors of CKD.
- The model stratified patients into low (6%), medium (40%), and high (70%) risk groups for developing CKD stage ≥3 by age 10.
Conclusions:
- The developed clinical model accurately predicts CKD risk in patients with PUVs.
- This model can aid clinicians in implementing timely interventions to prevent renal function impairment.
- Further refinement could incorporate factors like bladder dysfunction for enhanced predictive accuracy.
Background:
Posterior urethral valves (PUVs) are associated with severe consequences to the urinary tract and are a common cause of chronic kidney disease (CKD). The aim of this study was to develop clinical predictive model of CKD in a cohort of patients with PUVs.
Methods:
In this retrospective cohort study, 173 patients with PUVs were systematically followed up at a single tertiary unit. The primary endpoint was CKD ≥ stage 3. Survival analyses were performed by Cox regression proportional hazard models with time-fixed and time-dependent covariables.
Results:
Mean follow-up time was 83 months (SD, 70 months). Sixty-five children (37.6%) developed CKD stage ≥ 3. After adjustment by the time-dependent Cox model, baseline creatinine, nadir creatinine, hypertension, and proteinuria remained as predictors of the endpoint. After adjustment by time-fixed model, three variables were predictors of CKD ≥ stage 3: baseline creatinine, nadir creatinine, and proteinuria. The prognostic risk score was divided into three categories: low-risk (69 children, 39.9%), medium-risk (45, 26%), and high-risk (59, 34.1%). The probability of CKD ≥ stage 3 at 10 years age was estimated as 6%, 40%, and 70% for patients assigned to the low-risk, medium-risk, and high-risk groups, respectively (P < 0.001). The main limitation was the preclusion of some relevant variables, especially bladder dysfunction, that might contribute to a more accurate prediction of renal outcome.
Conclusion:
The model accurately predicts the risk of CKD in PUVs patients. This model could be clinically useful in applying timely intervention and in preventing the impairment of renal function.
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