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Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients

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Abstract

Background

Posterior urethral valves (PUV) is the most common cause of obstructive uropathy in boys; approximately 15% develop kidney failure by early adulthood. However, rates of kidney function decline are poorly defined in PUV children and adults, as is the impact of potentially modifiable chronic kidney disease (CKD) progression risk factors.

Methods

We conducted a retrospective review of all PUV patients followed at our institution from 1995 to 2018. Inclusion criteria were estimated glomerular filtration rate (eGFR) > 20 ml/min/1.73 m2 after 1 year of age, no dialysis or kidney transplant history, and ≥ 2 yearly serum creatinine values after age 1 year. eGFRs were calculated using creatinine-based estimating formulas for children (CKID U25) or adults (CKD-EPI). The primary outcome was annualized change in eGFR, assessed with linear mixed effects models. We also examined the association of acute kidney injury (AKI), proteinuria, hypertension (HTN), and recurrent febrile urinary tract infections (UTIs) with eGFR decline.

Results

Fifty-two PUV patients met the inclusion criteria. Median (interquartile range) eGFR decline was 2.6 (2.1, 3.1) ml/min/1.73 m2/year. Children (n = 35) and adults (n = 17) demonstrated progressive decline. Proteinuria and recurrent UTIs were significantly associated with faster progression; AKI and HTN were also associated but did not reach significance.

Conclusion

PUV patients show progressive loss of kidney function well into adulthood. Proteinuria and recurrent UTIs are associated with faster progression, suggesting potential modifiable risk factors. This is the first study to report annualized eGFR decline rates in PUV patients, which could help inform the design of clinical trials of CKD therapies.

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Data availability

The data that support the findings of this study may be available from the authors but restrictions apply to the availability of these data, which are the property of Cleveland Clinic and are not publicly available. Deidentified data, however, may be available from the authors upon reasonable request and with permission of Cleveland Clinic’s Law Department after an appropriate data use agreement has been fully executed.

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Funding

Research reported in this publication was supported in part by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number T35DK111373.

Author information

Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Victoria W. Huang, Katherine M. Dell & Audrey Rhee

  2. Department of Pediatrics, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Mohga Behairy & Katherine M. Dell

  3. Department of Urology, Cleveland Clinic, Cleveland, OH, USA

    Benjamin Abelson, Alice Crane & Audrey Rhee

  4. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA

    Wei Liu & Lu Wang

  5. Center for Pediatric Nephrology, Cleveland Clinic Children’s Hospital, Cleveland, OH, USA

    Katherine M. Dell

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  1. Victoria W. Huang
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Correspondence to Katherine M. Dell.

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The retrospective study was approved by the Cleveland Clinic Institutional Review Board (IRB).

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Victoria W. Huang and Mohga Behairy are co-first authors. Katherine M. Dell and Audrey Rhee are co-senior authors.

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Huang, V.W., Behairy, M., Abelson, B. et al. Kidney disease progression in pediatric and adult posterior urethral valves (PUV) patients. Pediatr Nephrol 39, 829–835 (2024). https://doi.org/10.1007/s00467-023-06128-0

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  • DOI: https://doi.org/10.1007/s00467-023-06128-0

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