Long-term renal outcomes in children with posterior urethral valves: a systematic review and meta-analysis

Posterior urethral valves (PUV) represent the most common cause of lower urinary tract obstruction in male infants and are a leading contributor to chronic kidney disease (CKD) in children. This systematic review and meta-analysis aimed to synthesize and quantify the available evidence regarding the risk of long-term CKD in children with posterior urethral valves and to identify factors associated with adverse renal outcomes.

A systematic review and meta-analysis were conducted in accordance with PRISMA and MOOSE guidelines. PubMed, Embase, Web of Science were searched from inception to January 31, 2026 for observational studies evaluating long-term renal outcomes in pediatric patients with posterior urethral valves. Eligible studies reported CKD outcomes, renal function decline, end-stage kidney disease, or need for renal replacement therapy with corresponding effect estimates or extractable data. Two reviewers independently screened studies, extracted data, and assessed methodological quality using Joanna Briggs Institute appraisal tools.

Nine cohort studies published between 1988 and 2024 met the inclusion criteria, representing pediatric populations from Europe, North America, South America, and Africa. Across studies, children with PUV demonstrated a substantial risk of long-term CKD, with many progressing to renal impairment or end-stage kidney disease during extended follow-up. Meta-analysis of within-study comparisons demonstrated that PUV children with adverse prognostic features (absence of pop-off mechanisms, elevated nadir creatinine, or established renal dysplasia) had a significantly higher risk of CKD compared with PUV children with more favorable prognostic profiles (pooled OR: 1.44, 95% CI: 1.20-1.73). Although effect sizes varied, the overall trend consistently indicated adverse renal outcomes. Studies identified important prognostic factors, including renal dysplasia, elevated nadir creatinine, bladder dysfunction, and delayed diagnosis, while the presence of pop-off mechanisms was frequently associated with improved renal prognosis. Substantial heterogeneity was observed among studies (I² = 89%). Funnel plot assessment suggested no significant publication bias.

This systematic review and meta-analysis demonstrates that children with posterior urethral valves remain at significant risk for developing long-term chronic kidney disease despite advances in early diagnosis and management. Future prospective studies are needed to refine prognostic models, standardize outcome reporting, and evaluate strategies aimed at preserving renal function and improving long-term health outcomes.