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Risk Factors for Early Chronic Kidney Disease IV-V in Children with Posterior Urethral Valves: A Retrospective Cohort

Gaurav Ray1, Suprita Kalra2, Aditi Sharma3

  • 1Department of Pediatrics, AFMC, Pune, Maharashtra, India.

Journal of Indian Association of Pediatric Surgeons
|June 18, 2026
PubMed

Insights

Bilateral kidney scarring is a key risk factor for early chronic kidney disease (CKD) progression in children with posterior urethral valves (PUV). Additional surgeries may offer protection against developing severe kidney disease.

Area of Science:

  • Pediatric Nephrology
  • Urology
  • Medical Imaging

Background:

  • Posterior urethral valves (PUV) are a common congenital anomaly in male infants, potentially leading to significant renal damage.
  • Early progression to advanced chronic kidney disease (CKD) stages IV-V in children with PUV remains a concern with limited research on risk factors.

Purpose of the Study:

  • To identify risk factors associated with early progression to CKD stages IV-V in children treated for PUV.
  • To evaluate the influence of specific clinical and imaging findings on renal outcomes.

Main Methods:

  • Retrospective review of medical records for 44 children diagnosed with PUV aged 1 month to 14 years.
  • Analysis of clinical data including age at diagnosis and management, postoperative serum creatinine, and renal scarring on DMSA scans.
  • Logistic regression analysis to determine significant risk factors and protective influences.

Main Results:

  • 15 children (34.09%) progressed to CKD IV-V before age 5, with a median age of progression at 16 months.
  • Bilateral renal scarring on DMSA scans and postoperative serum creatinine >1 mg/dl were significantly associated with early progression to CKD IV-V.
  • Additional surgeries showed a significant protective influence against progression to advanced CKD.

Conclusions:

  • Bilateral kidney scarring identified via DMSA scan is a significant risk factor for early progression to advanced CKD in children with PUV.
  • The need for additional surgeries, while indicating initial treatment complexity, demonstrated a protective effect on long-term renal outcomes.
Abstract

Keywords:
Chronic kidney diseasehypertensionposterior urethral valvesrenal scarringvesicoureteric reflux

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