Children with Posterior Urethral Valves Face Persistent Long-Term Risk of CKD: Study

A new study published in the journal of Pediatric Surgery International showed that despite major advancements in early identification and treatment, children with posterior urethral valves (PUV) still have a considerable long-term risk of developing chronic kidney disease (CKD).

A major contributor to children's CKD, PUV are the most frequent cause of lower urinary tract blockage in male babies. Thus, this systematic review and meta-analysis was set to identify variables linked to poor renal outcomes and to summarize and quantify the current data about the risk of long-term CKD in children with posterior urethral valves.

Following PRISMA and MOOSE criteria, a systematic review and meta-analysis were carried out. From the beginning until January 31, 2026, PubMed, Embase, and Web of Science were searched for observational studies assessing long-term renal outcomes in children patients with posterior urethral valves. CKD outcomes, renal function decrease, end-stage kidney disease, or the requirement for renal replacement treatment were reported in eligible trials along with related effect estimates or extractable data. The inclusion criteria were satisfied by 9 cohort studies that included pediatric populations from Europe, North America, South America, and Africa and were published between 1988 and 2024.

Children with PUV showed a significant risk of long-term CKD in all trials, and many of them developed renal impairment or end-stage kidney disease during the course of lengthy follow-up. In comparison to PUV children with more favorable prognostic profiles (pooled OR: 1.44, 95% CI: 1.20-1.73), PUV children with elevated nadir creatinine, adverse prognostic features (absence of pop-off mechanisms, or established renal dysplasia) had a significantly higher risk of CKD, according to a meta-analysis of within-study comparisons.

The overall trend consistently showed worse renal outcomes, despite differences in effect magnitude. Renal dysplasia, increased nadir creatinine, bladder dysfunction, and delayed diagnosis were found to be significant prognostic markers in studies, and the existence of pop-off mechanisms was often linked to an improved renal prognosis. There was significant variation amongst the trials (I² = 89%). The evaluation of the funnel plot revealed no discernible publishing bias.

Despite breakthroughs in early detection and treatment, children with posterior urethral valves continue to be at high risk of developing long-term chronic renal disease. Future prospective studies are needed to improve prognostic models, standardize outcome reporting, and assess methods for maintaining renal function and improving long-term health outcomes.

Reference:

Hafizar, ., Wahyudi, I., Situmorang, G. R., Risky Raharja, P. A., & Rodjani, A. (2026). Long-term renal outcomes in children with posterior urethral valves: a systematic review and meta-analysis. Pediatric Surgery International, 42(1). https://doi.org/10.1007/s00383-026-06511-6