ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005


The Latest on X

Kidney Week

Please note that you are viewing an archived section from 2023 and some content may be unavailable. To unlock all content for 2023, please visit the archives.

Abstract: FR-PO647

Long-Term Kidney Outcomes in Children with Posterior Urethral Valves: A Population-Based Cohort Study

Session Information

  • Pediatric Nephrology - II
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1900 Pediatric Nephrology


  • Robinson, Cal, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Rickard, Mandy, The Hospital for Sick Children, Toronto, Ontario, Canada
  • Jeyakumar, Nivethika, ICES, London, Ontario, Canada
  • Smith, Graham Douglas/D, ICES, London, Ontario, Canada
  • Dos Santos, Joana R., The Hospital for Sick Children, Toronto, Ontario, Canada
  • Chanchlani, Rahul, McMaster Children's Hospital, Hamilton, Ontario, Canada
  • Lorenzo, Armando, The Hospital for Sick Children, Toronto, Ontario, Canada

Posterior urethral valves (PUV) are a common cause of urinary tract obstruction in male infants. However, the long-term kidney outcomes of PUV are uncertain. We aim to determine the risk of major adverse kidney events (MAKE) among PUV patients.


Retrospective cohort study of all male infants (0-2yr) diagnosed with PUV from 1991-2021 in Ontario, Canada, identified by provincial administrative health databases. We chose two comparator cohorts of males (0-2yr) without PUV: 1) general pediatric population and 2) pyeloplasty patients. Patients were followed until death, provincial emigration, or March 2022 (89%). The primary outcome was modified MAKE (composite of death, chronic kidney replacement therapy (KRT), or de novo chronic kidney disease (CKD)).


We included 727 PUV patients, 855 pyeloplasty patients, and 1,013,052 general pediatric comparators. Median age at PUV diagnosis was 40 days (IQR 10-196). Median follow-up was 16.6 years (IQR 8.6-24.5). During follow-up, 32.3% of PUV patients developed MAKE vs. 5.8% of pyeloplasty patients and 0.8% of general comparators. The adjusted HR for MAKE throughout follow-up was 36.6 (95%CI 31.6-42.4, p<0.001) in PUV patients vs. general comparators. The cumulative incidence of CKD, chronic KRT, hypertension, and incident acute kidney injury were also higher among PUV patients.


PUV patients are at a substantially increased risk of long-term kidney sequelae vs. those without PUV. This justifies enhanced kidney function and blood pressure surveillance among those with a history of PUV.

Table. Cumulative incidence of outcomes
OutcomePUV patients, incidence rate per 1000py (95%CI)Pyeloplasty patients, incidence rate per 1000py (95%CI)General pediatric comparators, incidence rate per 1000py (95%CI)
Major adverse kidney event (MAKE)28.4 (25.0-32.2)4.5 (3.4-5.9)0.49 (0.48-0.50)
Kidney replacement therapy (chronic dialysis or kidney transplant)6.1 (4.7-7.8)0.5 (0.2-1.1)0.01 (0.01-0.01)
Chronic kidney disease26.2 (22.8-30.1)4.0 (3.0-5.7)0.24 (0.23-0.25)
Hypertension14.6 (12.3-17.3)4.3 (3.2-5.7)1.79 (1.77-1.81)
Acute kidney injury15.8 (13.4-18.6)2.8 (2.0-4.0)0.27 (0.26-0.28)

Figure. Cumulative incidence of MAKE among PUV patients vs general pediatric comparators