Chronic Kidney Disease Prevalence and Risk Factors for Children with Posterior Urethral Valve: A Single-Center Experience

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Methods A total of 52 boys followed with a diagnosis of posterior urethral valves were retrospectively evaluated. Clinical and laboratory data (serum creatinine levels and glomerular filtration rate, ultrasonographic findings, urodynamic study results, DMSA findings, and voiding cystourethrography results) were recorded. Results The mean age of the 52 patients was 9.8±4.8 years, and the mean age at diagnosis was 28±41 months. Antenatal diagnosis was present in 32 patients (64%) and, CKD developed in 10 patients (%19.2). There was no significant difference in antenatal diagnosis rates between patients with and without CKD. In the non-CKD group, hydronephrosis grades decreased significantly at the last follow-up compared with baseline, whereas no significant improvement was observed in the CKD group, these patients had more severe and persistent hydronephrosis at final evaluation. Patients with CKD had higher ratios of increased bladder wall thickness and renal echogenicity at baseline and ureteral dilatation at final follow-up. There was no significant difference between groups regarding severe bladder dysfunction, DMSA renal scarring, vesicoureteral reflux grades, recurrent urinary tract infections, or incontinence. Conclusion Our findings suggest that renal damage in children with PUVs predominantly develops during the antenatal period. Children presenting with persistent hydronephrosis and elevated serum creatinine levels at initial admission were at higher risk of developing CKD. Posterior urethral valve children risk factors chronic kidney disease long-term outcomes obstructive uropathy INTRODUCTION Posterior Urethral Valve (PUV) is the most common cause of lower urinary tract obstruction and obstruction related end stage renal disease in boys [ 1 , 2 ]. The incidence of PUV changes from 1/3000-1/8000 live births [ 3 ]. The severity and duration of obstruction determine the extent of renal damage and overall prognosis. Chronic kidney disease (CKD) develops in approximately 20–60% of boys with PUV, and 5–11% progress to end stage kidney disease [ 2 ]. Most cases of PUV could be diagnosed prenatally with ultrasonography [ 4 ]. Postnatal clinical findings, ultrasonography, voiding cystourethrography are important tools for raising suspicion of PUV, while cystoscopic evaluation remains the gold standard for diagnosis [ 5 ]. Multidisciplinary approach is essential in the follow-up of children with PUV. Although PUV is an anatomic obstruction, associated bladder dysfunction, vesicoureteral reflux, recurrent urinary tract infections, renal parenchymal damage, and progression to chronic disease necessitate close collaboration between nephrology and urology. In this study, we investigated children with PUV, evaluated the clinical, radiologic, and urodynamic findings, and aimed to identify factors associated with disease outcomes. MATERIAL AND METHODS We retrospectively reviewed the medical records of 52 patients diagnosed with PUV who were followed in the pediatric nephrology and pediatric urology department of our institution. Patients aged 6 months to 18 years who had been followed for a minimum of 6 months and had a confirmed diagnosis of PUV by cystoscopic evaluation were included in the study. Patient records were reviewed from the beginning of follow-up to the last control visit. Patients were classified as antenatal diagnosed if prenatal records demonstrated antenatal hydronephrosis, hydroureter, or increased bladder thickness; all others were classified as postnatally diagnosed. Age at diagnosis was defined as the age at the time of cystoscopic confirmation. Serum creatinine values were recorded at initial admission, at 6 months,1 year, 2-year, 3-year and at last follow-up visit. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula [5]. Chronic kidney disease was diagnosed and staged according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria [6]. Anthropometric measurements, blood pressure, urinary tract ultrasonography, frequency of urinary tract infections, urinalysis, spot urine protein/creatinine ratio, and voiding cystourethrography finding were recorded. Vesicoureteral reflux (VUR) was classified as low-grades (grades I-III) and high grade (IV-V). Urodynamic evaluations were performed in our center, including assessment of bladder capacity, bladder compliance, detrusor pressure, detrusor overactivity, and detrusor-sphincter dyssynergia. Patients presenting with two or more abnormal urodynamic findings were classified as having severe bladder dysfunction. Expected bladder capacity was calculated using the formula (age+2)x30. Detrusor pressure <45mmHg was considered normal. Statistics Descriptive statistics included mean, standard deviation, median, minimum and maximum values, as well as frequency and percentage distributions. The distribution of variables was assessed using the Kolmogorov-Smirnov test. For the analysis of quantitative independent variables, Independent Samples t-test and Mann-Whitney U test were used. For qualitative independent variables, Chi-Square test was applied, when the assumptions of the Chi-Square test were not met, Fisher’s exact test was used. The Wilcoxon signed-rank test was used for the analysis of dependent quantitative variables, while, the McNemar test was applied for dependent categorical variables. All statistical analyses were conducted using SPSS version 28.0. Informed consent was obtained from both parents and adolescents. Ethical approval was obtained from Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın City Hospital Ethics committee. The approval number date was 12.01.2022 and the approval number was 2021/0707. RESULTS A total of 52 children were included in the study, with a mean age of 9.8±4.8 years. The mean follow-up duration was 6.5±4.3 years (range, 6 months-14.5 years). Antenatal diagnosis was present in 32 patients (64%), of whom 8 progressed to chronic kidney disease (CKD). The age at initial admission ranged from 1 day to 11.7 years, with a mean age of 21.9±34.7 months. Thirty-one patients (59.6%) were diagnosed before 12 months of age. Children with and without CKD were similar in terms of current age, diagnosis age, and antenatal diagnosis (p>0.05; Table 1). Anthropometric measurements were also similar (data not shown). The most common reason for admission was abnormal prenatal ultrasonography. Other presenting complaints included urinary tract infections (n=11), enuresis (n=7), staccato voiding (n=4), abdominal pain, urosepsis, poor general condition, restlessness, and urinoma. At initial admission, 14 patients had an eGFR below the age-adjusted normal range. During follow-up renal function improved in five patients, whereas nine had persistently reduced eGFR. One patient had a normal eGFR at admission subsequently developed CKD during follow-up. Higher creatinine levels at admission were significantly associated with an increased risk of CKD compared with patients with normal baseline eGFR (p<0.0001). Peritoneal dialysis was initiated in three neonates. Renal function recovered in one patient, whereas two progressed to CKD. At the final follow-up, 10 of 52 patients (19.2%) had CKD: one was classified at stage 1, four as stage 2, two as stage 3, and three as stage 4 CKD. One patient underwent renal transplantation, and none were receiving dialysis at the time of last follow-up. Ultrasonographic Findings Ultrasonographic findings are summarized in Table 2. At admission, only 5.7% of patients had no hydronephrosis. Bilateral severe hydronephrosis (grade 3-4) was present in twenty-one children (40.3%), while bilateral mild hydronephrosis (grade 1-2) was observed in 15 (28.8%). Unilateral hydronephrosis was present in thirteen children, including two with severe dilatation. Increased renal echogenicity was observed in 13 patients, with unilateral involvement in four. At admission, ureteral dilatation was unilateral in 5 children (9.5%) and bilateral in 16 (30.5%). At the last follow-up, 4 patients had unilateral and 9 had bilateral ureteral dilatation. Increased bladder wall thickness was observed in 20 children at admission, and in 18 children at the final follow-up visit. Urinary Tract Infection Urinary tract infection (UTI) frequency was also evaluated. At admission, 9 of 52 patients had a documented UTI. During follow-up, 40 children (76.9%) experienced at least one UTI, and 39 (75%) received antibiotic prophylaxis. The mean lifetime UTI frequency was 3.7 episodes, corresponding to 0.5 infection/year (range, 1-14). Frequent UTIs (³ 2 episodes) were observed in thirty-two children (61.7%) and of whom six developed CKD. CKD development did not differ significantly between patients with and without frequent infections (p=0.911). However, children with CKD had higher prevalence of pyuria at initial admission compared to those without CKD (p=0.001). Lower Urinary Tract Symptoms Urinary incontinence was a common symptom, present in 17 of 52 children: six had enuresis and daytime incontinence, ten had only enuresis, and one had isolated daytime incontinence. At the final follow-up, eight children (15.4%) had persistent urinary incontinence. Based on clinical symptoms and urodynamic findings, 24 children (46%) received anticholinergic pills. Clean intermittent catheterization was initiated in eleven children, at the last follow up only one child was still performing catheterization. Urodynamic evaluation was performed in 45 children and 34 underwent follow-up urodynamic test (Table 3). Severe bladder dysfunction was present in 50% of children at initial UD evaluation, 53.2% at the follow-up assessment. There was no statistically significant association between severe bladder dysfunction and chronic kidney disease (p>0.05). Vesicostomy Vesicostomy was performed in 10 children (19%), due to inability to perform PUV ablation (n=8) and recurrent urinary tract infections (n=2). Vesicostomy closure was achieved in seven children by the last follow-up visit. The frequency of CKD was similar between children with and without vesicostomy (p=0.382). Renal Scar DMSA renal scintigraphy was performed in 49 children. Initial imaging demonstrated unilateral renal scarring in 15 children (30.6%) and bilateral scarring in 5 children (10.2%). Follow-up DMSA scans were available for 36 children, of whom 15 (41.7%) had unilateral and 7 (19.4%) had bilateral. The presence of renal scarring was not associated with CKD development (p=0.173). Vesicoureteral Reflux Voiding cystourethrography records (VCUG) were available for 50 children. Vesicoureteral reflux (VUR) was detected in 25 patients (48%), including 12 with bilateral high-grade VUR, 11 (%21.1) with unilateral high-grade VUR, and 2 (3.8%) with unilateral low grade VUR. Surgical correction for VUR was performed in seven children. Follow-up VCUG was available in 23 children, of whom 6 had persistent VUR. Repeat VCUG was performed in 11 children with a normal initial VCUG, all of whom remained normal. The rate of CKD development was similar between children with and without VUR (p=0.528). All children underwent cystoscopic evaluation for the diagnosis of PUV. Multiple surgical interventions were performed in 25 patients, with relook cystoscopy being the most common procedure. Additional interventions included unilateral ureteroneocystostomy (n=2), bilateral ureteroneocystostomy (n=3), pyeloplasty (n=1), bilateral subureteric injection (n=3), and nephrectomy (n=3). No patient underwent bladder neck reconstruction or bladder augmentation during follow-up. Prognosis At the last follow-up, 10 children (19.6%) had CKD. One had undergone kidney transplantation, and none required dialysis. Hypertension was observed in 4 children, and proteinuria in 5; while one child with hypertension had CKD, four of five children with proteinuria had CKD showing a significant association (p=0.001). Antibiotic prophylaxis for recurrent urinary tract infections was ongoing in 15 children. Urinary incontinence was present in eight patients (%15.3), and clean-intermittent catheterization was required in three children. DISCUSSION Posterior urethral valve is an important congenital anomaly associated with significant mortality and morbidity. A substantial proportion of affected children progresses to chronic kidney disease [ 2 – 4 , 7 ]. In this study, we evaluated the prevalence of chronic kidney disease in children with PUV and investigated factors associated with disease progression. Most cases in our cohort were diagnosed antenatally, reflecting recent advances in antenatal ultrasonography, which now allow detection of even milder forms of PUV. Vasconcelos et al. evaluated 173 children with PUV in United States and reported an antenatal diagnosis rate of 35.8% [ 3 ]. Similarly, a population-based study conducted in United Kingdom and Ireland, found an antenatal diagnosis rate of 35% [ 1 ]. In contrast, 64% of patients in our study were diagnosed antenatally; highlighting the importance of widespread antenatal ultrasonographic screening in our country. The impact of antenatal diagnosis on prognosis varies among studies. Vasconcelos et al. reported a similar prevalence of chronic kidney disease between antenatally and postnatally diagnosed subgroups [ 3 ]. Likewise, Ylinen et al. evaluated 46 children in 2004 and demonstrated comparable outcomes [ 7 ]. In contrast, Dinneen et al., reported poorer prognosis among children with antenatal diagnosis in 1993 [ 8 ]. The unfavourable outcomes reported in earlier studies may be attributed to limitations in healthcare services and diagnostic capabilities at that time. Approximately 60% of patients in our cohort were diagnosed before 1 years of age. El-Sherbiny et al. [ 9 ] demonstrated that children diagnosed before 1 year of age had more favourable renal outcomes and less upper urinary tract dilatation, which was attributed to earlier intervention, timely treatment, and shorter exposure to urinary tract obstruction. In contrast, Akdoğan et al. [ 10 ] reported similar prognosis across age groups, attributing this finding to the more severe clinical presentation of infants diagnosed before 1 year of age. In our cohort, renal outcomes were comparable between children diagnosed before 1 years of age and those diagnosed later. The most common presenting features in our cohort were antenatal suspicion of PUV, hydronephrosis, hydroureter, and increased bladder wall thickness, with a mean age at presentation of 21 months. Others presenting symptoms were recurrent urinary tract infections, enuresis, intermittent voiding, and back pain etc. In contrast, previous studies have reported a higher ratio of urinary tract infections at presentation [ 11 ]. At admission 14 (27%) had a reduced eGFR; renal function normalized in five, whereas nine had persistently decreased eGFR and were subsequently diagnosed with CKD. One additional patient with bilateral renal scarring and proteinuria also progressed to CKD. Consistent with our findings, several studies have demonstrated that the lowest serum creatinine before one years of life is the most important prognostic factor for the development of chronic kidney disease [ 4 ]. Similarly, a study from India involving 152 children identified serum creatinine as the strongest predictor of CKD. These observations further suggest the concept that renal damage in PUV largely results from renal dysplasia and antenatal injury, rather than postnatal events. In our study, the prevalence of CKD was 19.2%. Previous studies have reported CKD prevalence rates ranging from 20–60% [ 2 ]. Hennus et al., demonstrated a prevalence a CKD prevalence of 22% in a large cohort of 1.474 children [ 12 ]. In a study conducted in our country, Ezel Çelakil et al., reported a CKD prevalence of 35.9% [ 13 ]. Despite advances in the diagnosis and management of PUV, the prevalence of CKD remains relatively unchanged, likely reflecting irreversible renal injury occurring during the intrauterine period. At admission, hydronephrosis was present in 94.2% of the children. Patients without CKD showed a significant reduction in hydronephrosis at the last follow-up, whereas persistent hydronephrosis emerged as an important risk factor for the development of CKD. In addition, increased renal echogenicity was observed more frequently in children with CKD, consistent with previous reports [ 3 , 14 ]. We also demonstrated that hydroureter was significantly more common among children with CKD. Increased bladder wall thickness, a marker of bladder outlet obstruction, was another notable finding. At admission 15.3% of patients exhibited bladder wall thickness, this proportion increased to 25% during long-term follow-up, with no significant association with CKD development. Hochart et al, reported increased bladder wall thickness in 17% of children with PUV [ 15 ]. Recurrent urinary tract infections (UTIs) are among the most common and clinically important complications of PUV. In our cohort, 76.9% of patients experienced at least one UTI, and 75% received antibiotic prophylaxis. The prevalence of CKD was similar between patients with and without recurrent UTIs. Although some studies have reported poorer renal outcomes associated with recurrent infections, Bilgutay et al. demonstrated that recurrent UTIs are primarily associated with the need for repeated surgical interventions rather than the development of CKD [ 16 ]. Children with PUV frequently experience lower urinary tract symptoms, which can have a significantly important negative impact on quality of life [ 17 ]. In our cohort, urinary incontinence was present in 32.7% of patients at admission and persisted in 15.4% during follow-up. Similar to previous studies, urinary incontinence was not identified as a risk factor for the development of CKD [ 18 ]. In our cohort, 46% were received anticholinergic treatment and 21.2% required clean intermittent catheterization, rates comparable to those reported by McLeod et al. (53.9% and 21.6%) [ 19 ]. Urodynamic evaluation revealed severe bladder dysfunction in 50% of patients at admission and in 55.8% at last the follow-up, with no significant association between CKD development and urodynamic findings. Although bladder dysfunction has been reported in up to 75% of patients with PUV and has been associated with impaired renal function in several studies [ 20 ]. Warshaw et al. demonstrated that early CKD is predominantly related to renal dysplasia, whereas during adolescence and later life, bladder dysfunction becomes a major contributor to CKD development [ 21 ]. While a direct association between bladder dysfunction and CKD was not observed in our cohort, long-term follow-up remains essential for the early identification and management of bladder dysfunction in children with PUV. Vesicostomy is one of the most important surgical interventions in children with PUV. In our cohort, 20% of patients underwent vesicostomy, and the prevalence of CKD was similar between children with and without vesicostomy. Given that vesicostomy was primarily performed in patients with more severe disease, the comparable renal outcomes between groups may suggest a protective effect of this intervention. Similar observations have been reported by Kim et al. [ 22 ]. DMSA scintigraphy demonstrated renal scarring in 40.8% of patients at initial admission, which increased to 61.1% at the last follow-up. Bhadoo et al. reported a renal scarring rate of 56.6% and found no association between renal scarring and poor renal prognosis or CKD development [ 20 ]. Similarly, Ylinen et al. showed that the presence of renal scarring at admission or during last follow-up was not associated with CKD [ 4 ]. These findings suggest that the majority of renal scarring occurs during the antenatal period rather than resulting from postnatal disease progression. Vesicoureteral reflux was present in approximately half of the patients in our cohort, with 23% exhibiting bilateral high-grade reflux. Heikkilä et al. reported VUR in 64% of patients, with bilateral involvement in 37%, and demonstrated a poorer prognosis in children with VUR [ 23 ]. While some studies have identified an association between VUR and adverse outcomes, others have reported comparable prognosis regardless of VUR status [ 25 ]. In our study, renal outcomes were similar between children with and without VUR. Proteinuria was observed in only five patients in our cohort; however, 80% of these children developed CKD. Vasconcelos et al., reported similar finding, highlighting proteinuria as an important marker of adverse renal prognosis [ 3 ]. These results underscore the need for long-term follow-up and close monitoring of proteinuria in children with PUV. In conclusion, the prevalence of CKD in our cohort was 19.2%. Antenatal hydronephrosis was the most common reason for initial presentation in children with PUV. Renal outcomes were comparable between patients diagnosed antenatally and postnatally. Persistent hydronephrosis, low eGFR at admission, increased renal echogenicity, and the presence of hydroureter were significantly associated with the development of CKD. In contrast, vesicoureteral reflux, recurrent urinary tract infections, and bladder dysfunction were not associated with CKD in our cohort. Overall, our findings suggest that the majority of renal injury and scarring occurs during the antenatal period, likely reflecting underlying renal dysplasia, rather than postnatal disease progression. Declarations Ethical approval was obtained from the Ethics committee of Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın City Hospital. The study was approved on 12.01.2022 and the approval number was 2021/0707. Funding Source: No funding was received for this study. Conflict of interest: None Author Contribution S.I, D.U and N.G. designed the work and wrote the manuscript. S.İ collected the data. All authors reviewed the manuscript. 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(2018) Long-term outcomes of kidney and bladder function in patients with a posterior urethral valve. Medicine (Baltimore) 97(23):e11033 doi: 0.1097/MD.0000000000011033 Heikkilä J, Rintala R, Taskinen S (2009) Vesicoureteral reflux in conjunction with posterior urethral valves. J Urol 182(4):1555–1560. doi:10.10.16/j.juro.2009.06.057 Sarhan OM, El-Ghoneimi AA, Helmy TE et al. (2011) Posterior urethral valves: Multivariate analysis of factors affecting the final renal outcome. J Urol 185; 2491–2496. doi: 10.1016/j.juro.2011.01023 Zhang W, Li P, Zhou H (2022) Mid-short-term risk factors for chronic renal failure in children with posterior urethral valve. Pediatr Surg Int 38(9):1321–1326. doi: 10.1007/s00383-022-05154-7 Tables Tables 1 to 3 are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8886401","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":598351767,"identity":"1a9a8f39-66b3-4840-8420-3c37e4d4528f","order_by":0,"name":"Sibel Inceoğlu","email":"","orcid":"","institution":"Medeniyet Üniversitesi Göztepe Eğitim ve Araştırma Hastanesi","correspondingAuthor":false,"prefix":"","firstName":"Sibel","middleName":"","lastName":"Inceoğlu","suffix":""},{"id":598351772,"identity":"d60748af-83c3-42f5-8b33-07ce6a0ebc7c","order_by":1,"name":"Diana Uçkardeş","email":"","orcid":"","institution":"Istanbul Medeniyet University","correspondingAuthor":false,"prefix":"","firstName":"Diana","middleName":"","lastName":"Uçkardeş","suffix":""},{"id":598351774,"identity":"0d9724c8-8bed-4245-8b5a-5a2ebbab5aae","order_by":2,"name":"Nilüfer Göknar","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7klEQVRIiWNgGAWjYDACZuYGhgoQgwdEVEBF8GthbGA4A9dyBiqCHyBrYWyDiuAD5uyMbRIHKu7Z9fOcPfi5cl5tNH87UMuPim04tVg2g7ScKU6e2duXLHl22/HcGYcZGxh7ztzGqcXgMGOb9Me2hGSD8zwGko3bjuU2ALUwM7bh1yJx8B9Yi/HPxjnHcucTp6Uhwc7gbI+ZZGNDTe4GIrQ0Wxw4lpAg2XPGzLLh2IHcjUAtB/H65fzhgzcO1CTY8/PkGN9sqKnLnQcUefCjArcWGEhsgNCHweQBguqBwB5K1xGjeBSMglEwCkYYAACmLl+Gh8aNkAAAAABJRU5ErkJggg==","orcid":"","institution":"Istanbul Medeniyet University","correspondingAuthor":true,"prefix":"","firstName":"Nilüfer","middleName":"","lastName":"Göknar","suffix":""}],"badges":[],"createdAt":"2026-02-15 13:53:10","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8886401/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8886401/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1007/s11255-026-05149-6","type":"published","date":"2026-04-17T15:56:57+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":107351724,"identity":"cea08b14-da37-4acc-86ca-2bce08b13b9b","added_by":"auto","created_at":"2026-04-20 16:11:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":223604,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8886401/v1/734ea693-a662-4a7e-b658-91b9a1a102a2.pdf"},{"id":103773053,"identity":"d3ff261e-c779-49a4-bd1a-7db98f5fe089","added_by":"auto","created_at":"2026-03-02 17:40:25","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":33032,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-8886401/v1/7c66f4e5e0839cc238f4832d.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Chronic Kidney Disease Prevalence and Risk Factors for Children with Posterior Urethral Valve: A Single-Center Experience","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003ePosterior Urethral Valve (PUV) is the most common cause of lower urinary tract obstruction and obstruction related end stage renal disease in boys [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The incidence of PUV changes from 1/3000-1/8000 live births [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The severity and duration of obstruction determine the extent of renal damage and overall prognosis. Chronic kidney disease (CKD) develops in approximately 20\u0026ndash;60% of boys with PUV, and 5\u0026ndash;11% progress to end stage kidney disease [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMost cases of PUV could be diagnosed prenatally with ultrasonography [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Postnatal clinical findings, ultrasonography, voiding cystourethrography are important tools for raising suspicion of PUV, while cystoscopic evaluation remains the gold standard for diagnosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMultidisciplinary approach is essential in the follow-up of children with PUV. Although PUV is an anatomic obstruction, associated bladder dysfunction, vesicoureteral reflux, recurrent urinary tract infections, renal parenchymal damage, and progression to chronic disease necessitate close collaboration between nephrology and urology.\u003c/p\u003e \u003cp\u003eIn this study, we investigated children with PUV, evaluated the clinical, radiologic, and urodynamic findings, and aimed to identify factors associated with disease outcomes.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eWe retrospectively reviewed the medical records of 52 patients diagnosed with PUV who were followed in the pediatric nephrology and pediatric urology department of our institution. Patients aged 6 months to 18 years who had been followed for a minimum of 6 months and had a confirmed diagnosis of PUV by cystoscopic evaluation were included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePatient records were reviewed from the beginning of follow-up to the last control visit. Patients were classified as antenatal diagnosed if prenatal records demonstrated antenatal hydronephrosis, hydroureter, or increased bladder thickness; all others were classified as postnatally diagnosed. Age at diagnosis was defined as the age at the time of cystoscopic confirmation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSerum creatinine values were recorded at initial admission, at 6 months,1 year, 2-year, 3-year and at last follow-up visit. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula [5]. Chronic kidney disease was diagnosed and staged according to Kidney Disease: Improving Global Outcomes (KDIGO) criteria [6]. Anthropometric measurements, blood pressure, urinary tract ultrasonography, frequency of urinary tract infections, urinalysis, spot urine protein/creatinine ratio, and voiding cystourethrography finding were recorded. Vesicoureteral reflux (VUR) was classified as low-grades (grades I-III) and high grade (IV-V).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUrodynamic evaluations were performed in our center, including assessment of bladder capacity, bladder compliance, detrusor pressure, detrusor overactivity, and detrusor-sphincter dyssynergia. Patients presenting with two or more abnormal urodynamic findings were classified as having severe bladder dysfunction. Expected bladder capacity was calculated using the formula (age+2)x30. Detrusor pressure \u0026lt;45mmHg was considered normal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics included mean, standard deviation, median, minimum and maximum values, as well as frequency and percentage distributions. The distribution of variables was assessed using the Kolmogorov-Smirnov test. For the analysis of quantitative independent variables, Independent Samples t-test and Mann-Whitney U test were used. For qualitative independent variables, Chi-Square test was applied, when the assumptions of the Chi-Square test were not met, Fisher’s exact test was used. The Wilcoxon signed-rank test was used for the analysis of dependent quantitative variables, while, the McNemar test was applied for dependent categorical variables. All statistical analyses were conducted using SPSS version 28.0.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from both parents and adolescents. Ethical approval was obtained from Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın City Hospital Ethics committee. The approval number date was 12.01.2022 and the approval number was 2021/0707. \u0026nbsp;\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 52 children were included in the study, with a mean age of 9.8±4.8 years. The mean follow-up duration was 6.5±4.3 years (range, 6 months-14.5 years). Antenatal diagnosis was present in 32 patients (64%), of whom 8 progressed to chronic kidney disease (CKD). The age at initial admission ranged from 1 day to 11.7 years, with a mean age of 21.9±34.7 months. Thirty-one patients (59.6%) were diagnosed before 12 months of age. Children with and without CKD were similar in terms of current age, diagnosis age, and antenatal diagnosis (p\u0026gt;0.05; Table 1). Anthropometric measurements were also similar (data not shown).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe most common reason for admission was abnormal prenatal ultrasonography. Other presenting complaints included urinary tract infections (n=11), enuresis (n=7), staccato voiding (n=4), abdominal pain, urosepsis, poor general condition, restlessness, and urinoma. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAt initial admission, 14 patients had an eGFR below the age-adjusted normal range. During follow-up renal function improved in five patients, whereas nine had persistently reduced eGFR. One patient had a normal eGFR at admission subsequently developed CKD during follow-up. Higher creatinine levels at admission were significantly associated with an increased risk of CKD compared with patients with normal baseline eGFR (p\u0026lt;0.0001). \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePeritoneal dialysis was initiated in three neonates. Renal function recovered in one patient, whereas two progressed to CKD. At the final follow-up, 10 of 52 patients (19.2%) had CKD: one was classified at stage 1, four as stage 2, two as stage 3, and three as stage 4 CKD. One patient underwent renal transplantation, and none were receiving dialysis at the time of last follow-up. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUltrasonographic Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUltrasonographic findings are summarized in Table 2. At admission, only 5.7% of patients had no hydronephrosis. Bilateral severe hydronephrosis (grade 3-4) was present in twenty-one children (40.3%), while bilateral mild hydronephrosis (grade 1-2) was observed in 15 (28.8%). Unilateral hydronephrosis was present in thirteen children, including two with severe dilatation. Increased renal echogenicity was observed in 13 patients, with unilateral involvement in four.\u003c/p\u003e\n\u003cp\u003eAt admission, ureteral dilatation was unilateral in 5 children (9.5%) and bilateral in 16 (30.5%). At the last follow-up, 4 patients had unilateral and 9 had bilateral ureteral dilatation. Increased bladder wall thickness was observed in 20 children at admission, and in 18 children at the final follow-up visit.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUrinary Tract Infection\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUrinary tract infection (UTI) frequency was also evaluated. At admission, 9 of 52 patients had a documented UTI. \u0026nbsp;During follow-up, 40 children (76.9%) experienced at least one UTI, and 39 (75%) received antibiotic prophylaxis. The mean lifetime UTI frequency was 3.7 episodes, corresponding to 0.5 infection/year (range, 1-14). Frequent UTIs (³\u0026nbsp;2 episodes) were observed in thirty-two children (61.7%) and of whom six developed CKD. CKD development did not differ significantly between patients with and without frequent infections (p=0.911). However, children with CKD had higher prevalence of pyuria at initial admission compared to those without CKD (p=0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLower Urinary Tract Symptoms\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUrinary incontinence was a common symptom, present in 17 of 52 children: six had enuresis and daytime incontinence, ten had only enuresis, and one had isolated daytime incontinence. At the final follow-up, eight children (15.4%) had persistent urinary incontinence. Based on clinical symptoms and urodynamic findings, 24 children (46%) received anticholinergic pills. Clean intermittent catheterization was initiated in eleven children, at the last follow up only one child was still performing catheterization.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUrodynamic evaluation was performed in 45 children and 34 underwent follow-up urodynamic test (Table 3). Severe bladder dysfunction was present in 50% of children at initial UD evaluation, 53.2% at the follow-up assessment. There was no statistically significant association between severe bladder dysfunction and chronic kidney disease (p\u0026gt;0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVesicostomy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVesicostomy was performed in 10 children (19%), due to inability to perform PUV ablation (n=8) and recurrent urinary tract infections (n=2). Vesicostomy closure was achieved in seven children by the last follow-up visit. The frequency of CKD was similar between children with and without vesicostomy (p=0.382).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRenal Scar\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDMSA renal scintigraphy was performed in 49 children. Initial imaging demonstrated unilateral renal scarring in 15 children (30.6%) and bilateral scarring in 5 children (10.2%). Follow-up DMSA scans were available for 36 children, of whom 15 (41.7%) had unilateral and 7 (19.4%) had bilateral. The presence of renal scarring was not associated with CKD development (p=0.173). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVesicoureteral Reflux\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eVoiding cystourethrography records (VCUG) were available for 50 children. Vesicoureteral reflux (VUR) was detected in 25 patients (48%), including 12 with bilateral high-grade VUR, 11 (%21.1) with unilateral high-grade VUR, and 2 (3.8%) with unilateral low grade VUR. Surgical correction for VUR was performed in seven children. Follow-up VCUG was available in 23 children, of whom 6 had persistent VUR. Repeat VCUG was performed in 11 children with a normal initial VCUG, all of whom remained normal. The rate of CKD development was similar between children with and without VUR (p=0.528).\u003c/p\u003e\n\u003cp\u003eAll children underwent cystoscopic evaluation for the diagnosis of PUV. Multiple surgical interventions were performed in 25 patients, with relook cystoscopy being the most common procedure. Additional interventions included unilateral ureteroneocystostomy (n=2), bilateral ureteroneocystostomy (n=3), pyeloplasty (n=1), bilateral subureteric injection (n=3), and nephrectomy (n=3). No patient underwent bladder neck reconstruction or bladder augmentation during follow-up. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrognosis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAt the last follow-up, 10 children (19.6%) had CKD. One had undergone kidney transplantation, and none required dialysis. Hypertension was observed in 4 children, and proteinuria in 5; while one child with hypertension had CKD, four of five children with proteinuria had CKD showing a significant association (p=0.001). Antibiotic prophylaxis for recurrent urinary tract infections was ongoing in 15 children. Urinary incontinence was present in eight patients (%15.3), and clean-intermittent catheterization was required in three children.\u0026nbsp;\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003ePosterior urethral valve is an important congenital anomaly associated with significant mortality and morbidity. A substantial proportion of affected children progresses to chronic kidney disease [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In this study, we evaluated the prevalence of chronic kidney disease in children with PUV and investigated factors associated with disease progression.\u003c/p\u003e \u003cp\u003eMost cases in our cohort were diagnosed antenatally, reflecting recent advances in antenatal ultrasonography, which now allow detection of even milder forms of PUV. Vasconcelos et al. evaluated 173 children with PUV in United States and reported an antenatal diagnosis rate of 35.8% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Similarly, a population-based study conducted in United Kingdom and Ireland, found an antenatal diagnosis rate of 35% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In contrast, 64% of patients in our study were diagnosed antenatally; highlighting the importance of widespread antenatal ultrasonographic screening in our country. The impact of antenatal diagnosis on prognosis varies among studies. Vasconcelos et al. reported a similar prevalence of chronic kidney disease between antenatally and postnatally diagnosed subgroups [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Likewise, Ylinen et al. evaluated 46 children in 2004 and demonstrated comparable outcomes [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In contrast, Dinneen et al., reported poorer prognosis among children with antenatal diagnosis in 1993 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The unfavourable outcomes reported in earlier studies may be attributed to limitations in healthcare services and diagnostic capabilities at that time.\u003c/p\u003e \u003cp\u003eApproximately 60% of patients in our cohort were diagnosed before 1 years of age. El-Sherbiny et al. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] demonstrated that children diagnosed before 1 year of age had more favourable renal outcomes and less upper urinary tract dilatation, which was attributed to earlier intervention, timely treatment, and shorter exposure to urinary tract obstruction. In contrast, Akdoğan et al. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] reported similar prognosis across age groups, attributing this finding to the more severe clinical presentation of infants diagnosed before 1 year of age. In our cohort, renal outcomes were comparable between children diagnosed before 1 years of age and those diagnosed later.\u003c/p\u003e \u003cp\u003eThe most common presenting features in our cohort were antenatal suspicion of PUV, hydronephrosis, hydroureter, and increased bladder wall thickness, with a mean age at presentation of 21 months. Others presenting symptoms were recurrent urinary tract infections, enuresis, intermittent voiding, and back pain etc. In contrast, previous studies have reported a higher ratio of urinary tract infections at presentation [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAt admission 14 (27%) had a reduced eGFR; renal function normalized in five, whereas nine had persistently decreased eGFR and were subsequently diagnosed with CKD. One additional patient with bilateral renal scarring and proteinuria also progressed to CKD. Consistent with our findings, several studies have demonstrated that the lowest serum creatinine before one years of life is the most important prognostic factor for the development of chronic kidney disease [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similarly, a study from India involving 152 children identified serum creatinine as the strongest predictor of CKD. These observations further suggest the concept that renal damage in PUV largely results from renal dysplasia and antenatal injury, rather than postnatal events.\u003c/p\u003e \u003cp\u003eIn our study, the prevalence of CKD was 19.2%. Previous studies have reported CKD prevalence rates ranging from 20\u0026ndash;60% [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Hennus et al., demonstrated a prevalence a CKD prevalence of 22% in a large cohort of 1.474 children [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a study conducted in our country, Ezel \u0026Ccedil;elakil et al., reported a CKD prevalence of 35.9% [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite advances in the diagnosis and management of PUV, the prevalence of CKD remains relatively unchanged, likely reflecting irreversible renal injury occurring during the intrauterine period.\u003c/p\u003e \u003cp\u003eAt admission, hydronephrosis was present in 94.2% of the children. Patients without CKD showed a significant reduction in hydronephrosis at the last follow-up, whereas persistent hydronephrosis emerged as an important risk factor for the development of CKD. In addition, increased renal echogenicity was observed more frequently in children with CKD, consistent with previous reports [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. We also demonstrated that hydroureter was significantly more common among children with CKD.\u003c/p\u003e \u003cp\u003eIncreased bladder wall thickness, a marker of bladder outlet obstruction, was another notable finding. At admission 15.3% of patients exhibited bladder wall thickness, this proportion increased to 25% during long-term follow-up, with no significant association with CKD development. Hochart et al, reported increased bladder wall thickness in 17% of children with PUV [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRecurrent urinary tract infections (UTIs) are among the most common and clinically important complications of PUV. In our cohort, 76.9% of patients experienced at least one UTI, and 75% received antibiotic prophylaxis. The prevalence of CKD was similar between patients with and without recurrent UTIs. Although some studies have reported poorer renal outcomes associated with recurrent infections, Bilgutay et al. demonstrated that recurrent UTIs are primarily associated with the need for repeated surgical interventions rather than the development of CKD [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eChildren with PUV frequently experience lower urinary tract symptoms, which can have a significantly important negative impact on quality of life [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In our cohort, urinary incontinence was present in 32.7% of patients at admission and persisted in 15.4% during follow-up. Similar to previous studies, urinary incontinence was not identified as a risk factor for the development of CKD [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In our cohort, 46% were received anticholinergic treatment and 21.2% required clean intermittent catheterization, rates comparable to those reported by McLeod et al. (53.9% and 21.6%) [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eUrodynamic evaluation revealed severe bladder dysfunction in 50% of patients at admission and in 55.8% at last the follow-up, with no significant association between CKD development and urodynamic findings. Although bladder dysfunction has been reported in up to 75% of patients with PUV and has been associated with impaired renal function in several studies [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Warshaw et al. demonstrated that early CKD is predominantly related to renal dysplasia, whereas during adolescence and later life, bladder dysfunction becomes a major contributor to CKD development [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. While a direct association between bladder dysfunction and CKD was not observed in our cohort, long-term follow-up remains essential for the early identification and management of bladder dysfunction in children with PUV.\u003c/p\u003e \u003cp\u003eVesicostomy is one of the most important surgical interventions in children with PUV. In our cohort, 20% of patients underwent vesicostomy, and the prevalence of CKD was similar between children with and without vesicostomy. Given that vesicostomy was primarily performed in patients with more severe disease, the comparable renal outcomes between groups may suggest a protective effect of this intervention. Similar observations have been reported by Kim et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDMSA scintigraphy demonstrated renal scarring in 40.8% of patients at initial admission, which increased to 61.1% at the last follow-up. Bhadoo et al. reported a renal scarring rate of 56.6% and found no association between renal scarring and poor renal prognosis or CKD development [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Similarly, Ylinen et al. showed that the presence of renal scarring at admission or during last follow-up was not associated with CKD [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These findings suggest that the majority of renal scarring occurs during the antenatal period rather than resulting from postnatal disease progression.\u003c/p\u003e \u003cp\u003eVesicoureteral reflux was present in approximately half of the patients in our cohort, with 23% exhibiting bilateral high-grade reflux. Heikkil\u0026auml; et al. reported VUR in 64% of patients, with bilateral involvement in 37%, and demonstrated a poorer prognosis in children with VUR [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. While some studies have identified an association between VUR and adverse outcomes, others have reported comparable prognosis regardless of VUR status [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In our study, renal outcomes were similar between children with and without VUR.\u003c/p\u003e \u003cp\u003eProteinuria was observed in only five patients in our cohort; however, 80% of these children developed CKD. Vasconcelos et al., reported similar finding, highlighting proteinuria as an important marker of adverse renal prognosis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. These results underscore the need for long-term follow-up and close monitoring of proteinuria in children with PUV.\u003c/p\u003e \u003cp\u003eIn conclusion, the prevalence of CKD in our cohort was 19.2%. Antenatal hydronephrosis was the most common reason for initial presentation in children with PUV. Renal outcomes were comparable between patients diagnosed antenatally and postnatally. Persistent hydronephrosis, low eGFR at admission, increased renal echogenicity, and the presence of hydroureter were significantly associated with the development of CKD. In contrast, vesicoureteral reflux, recurrent urinary tract infections, and bladder dysfunction were not associated with CKD in our cohort. Overall, our findings suggest that the majority of renal injury and scarring occurs during the antenatal period, likely reflecting underlying renal dysplasia, rather than postnatal disease progression.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eEthical approval\u003c/h2\u003e \u003cp\u003e was obtained from the Ethics committee of Istanbul Medeniyet University, Goztepe Prof. Dr. Suleyman Yalcın City Hospital. The study was approved on 12.01.2022 and the approval number was 2021/0707.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Source:\u003c/h2\u003e \u003cp\u003eNo funding was received for this study.\u003c/p\u003e \u003cp\u003eConflict of interest: None\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.I, D.U and N.G. designed the work and wrote the manuscript. S.İ collected the data. All authors reviewed the manuscript. All authors contributed to manuscript revision and approved the final version.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBrownlee E, Wragg R, Robb A, et al; BAPS-CASS (2019) Current epidemiology and antenatal presentation of posterior urethral valves: Outcome of BAPS CASS National Audit. J Pediatr Surg 54(2):318\u0026ndash;321. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps//doi:10.1016/j.jpedsurg.2018.10.091\u003c/span\u003e\u003cspan address=\"https://doi:10.1016/j.jpedsurg.2018.10.091\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnsari MS, Surdas R, Barai S, Srivastava A, Kapoor R (2011) Renal function reserve in children with posterior urethral valve: A novel test to predict long-term outcome. 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(2016) Posterior urethral valves: are neonatal imaging findings predictive of renal function during early childhood. Pediatr Radiol. 46(10):1418\u0026ndash;23 doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00247-016-3632-7\u003c/span\u003e\u003cspan address=\"10.1007/s00247-016-3632-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBilgutay AN, Roth DR, Gonzales ET Jr et al. (2016) Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol 12(3):179.e1-7. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.jpurol.2015.10.009\u003c/span\u003e\u003cspan address=\"10.1016/j.jpurol.2015.10.009\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKahraman K, G\u0026ouml;knar N. Impact of posterior urethral valve on patient quality of life and caregiver burden. World J Urol. 2025;43(1):582. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00345-025-05970-1\u003c/span\u003e\u003cspan address=\"10.1007/s00345-025-05970-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 41015587.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGhanem MA, Wolffenbuttel KP, De Vylder A, Nijman RJ (2004) Long-term Bladder Dysfunction and Renal Function in Boys with Posterior Urethral Valves Based on Urodynamic Findings. J Urol 171(6 Pt 1):2409\u0026ndash;2412. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01.ju.0000127762.95045.93\u003c/span\u003e\u003cspan address=\"10.1097/01.ju.0000127762.95045.93\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcLeod DJ, Szymanski KM, Gong E et al.; Pediatric Urology Midwest Alliance (PUMA) (2019) Renal replacement therapy and intermittent catheterization risk in posterior urethral valves Journal of the American Academy of Pediatrics. 143(3):e20182656 doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/peds.2018-2656\u003c/span\u003e\u003cspan address=\"10.1542/peds.2018-2656\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhadoo D, Bajpai M, Panda SS (2014) Posterior urethral valve: prognostic factors and renal outcome. J Indian Assoc Pediatr Surg. 2014 19(3):133\u0026ndash;137. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0971-9261.136459\u003c/span\u003e\u003cspan address=\"10.4103/0971-9261.136459\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWarshaw BL, Hymes LC, Trulock TS, Woodard JR (1985) Prognostic features in infants with obstructive uropathy due to posterior urethral valves. J Urol 133(2):240\u0026ndash;243. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/s0022-5347(17)48899-9\u003c/span\u003e\u003cspan address=\"10.1016/s0022-5347(17)48899-9\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim SJ, Jung J, Lee C, Park S et al. (2018) Long-term outcomes of kidney and bladder function in patients with a posterior urethral valve. Medicine (Baltimore) 97(23):e11033 doi: 0.1097/MD.0000000000011033\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeikkil\u0026auml; J, Rintala R, Taskinen S (2009) Vesicoureteral reflux in conjunction with posterior urethral valves. J Urol 182(4):1555\u0026ndash;1560. doi:10.10.16/j.juro.2009.06.057\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarhan OM, El-Ghoneimi AA, Helmy TE et al. (2011) Posterior urethral valves: Multivariate analysis of factors affecting the final renal outcome. J Urol 185; 2491\u0026ndash;2496. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.juro.2011.01023\u003c/span\u003e\u003cspan address=\"10.1016/j.juro.2011.01023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang W, Li P, Zhou H (2022) Mid-short-term risk factors for chronic renal failure in children with posterior urethral valve. Pediatr Surg Int 38(9):1321\u0026ndash;1326. doi: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00383-022-05154-7\u003c/span\u003e\u003cspan address=\"10.1007/s00383-022-05154-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 3 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Posterior urethral valve, children, risk factors, chronic kidney disease, long-term outcomes, obstructive uropathy","lastPublishedDoi":"10.21203/rs.3.rs-8886401/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8886401/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe aim of this study is to determine the prevalence of CKD in children with PUV and to identify risk factors associated with progression to CKD.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA total of 52 boys followed with a diagnosis of posterior urethral valves were retrospectively evaluated. Clinical and laboratory data (serum creatinine levels and glomerular filtration rate, ultrasonographic findings, urodynamic study results, DMSA findings, and voiding cystourethrography results) were recorded.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe mean age of the 52 patients was 9.8\u0026plusmn;4.8 years, and the mean age at diagnosis was 28\u0026plusmn;41 months. Antenatal diagnosis was present in 32 patients (64%) and, CKD developed in 10 patients (%19.2). There was no significant difference in antenatal diagnosis rates between patients with and without CKD. In the non-CKD group, hydronephrosis grades decreased significantly at the last follow-up compared with baseline, whereas no significant improvement was observed in the CKD group, these patients had more severe and persistent hydronephrosis at final evaluation. Patients with CKD had higher ratios of increased bladder wall thickness and renal echogenicity at baseline and ureteral dilatation at final follow-up. There was no significant difference between groups regarding severe bladder dysfunction, DMSA renal scarring, vesicoureteral reflux grades, recurrent urinary tract infections, or incontinence.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOur findings suggest that renal damage in children with PUVs predominantly develops during the antenatal period. Children presenting with persistent hydronephrosis and elevated serum creatinine levels at initial admission were at higher risk of developing CKD.\u003c/p\u003e","manuscriptTitle":"Chronic Kidney Disease Prevalence and Risk Factors for Children with Posterior Urethral Valve: A Single-Center Experience","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-02 17:39:49","doi":"10.21203/rs.3.rs-8886401/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a9d53eab-3b4f-4d3a-bf23-50da15089173","owner":[],"postedDate":"March 2nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:09:34+00:00","versionOfRecord":{"articleIdentity":"rs-8886401","link":"https://doi.org/10.1007/s11255-026-05149-6","journal":{"identity":"international-urology-and-nephrology","isVorOnly":false,"title":"International Urology and Nephrology"},"publishedOn":"2026-04-17 15:56:57","publishedOnDateReadable":"April 17th, 2026"},"versionCreatedAt":"2026-03-02 17:39:49","video":"","vorDoi":"10.1007/s11255-026-05149-6","vorDoiUrl":"https://doi.org/10.1007/s11255-026-05149-6","workflowStages":[]},"version":"v1","identity":"rs-8886401","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8886401","identity":"rs-8886401","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}