Kidney Week

Abstract: TH-PO1188

Proteinuria as a Risk Factor for CKD Progression in Patients with Posterior Urethral Valves

Session Information

• Pediatric Nephrology: CV Health, CKD, AKI, Dialysis, Transplantation, and Health Services Research
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

• 1800 Pediatric Nephrology

Authors

• Heilbronner, Alison K., Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio, United States

Alison K. Heilbronner

• Nowacki, Amy S., Department of Qualitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, United States

Amy S. Nowacki, MS, PhD

• Weaver, John, Section of Pediatric Urology, Department of Urology, Cleveland Clinic, Cleveland, Ohio, United States

John Weaver, MD

• Furth, Susan L., Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States

Susan L. Furth, MD, PhD

• Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States

Bradley A. Warady, MD

• Matheson, Matthew, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Matthew Matheson

• Ng, Derek K., Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, United States

Derek K. Ng, PhD

• Dell, Katherine MacRae, Section of Pediatric Nephrology and Hypertension, Cleveland Clinic Children's, Cleveland, Ohio, United States

Katherine MacRae Dell, MD

Group or Team Name

• On behalf of the CKiD investigators

Background

Posterior urethral valves (PUV) is the most common cause of congenital obstructive uropathy in boys. Approximately 15% of patients progress to kidney failure during childhood. Prior studies have investigated potential risk factors for chronic kidney disease (CKD) progression, but were limited by retrospective analyses, serum creatinine-only based estimated glomerular filtration rates (eGFR) or a focus on perinatal risk factors (e.g., oligohydramnios). Potentially modifiable risk factors (e.g., proteinuria) have not been well evaluated. In this study, we used the prospectively collected data from the Chronic Kidney Disease in Children (CKiD) study, which includes measured GFRs, to estimate CKD progression rates and evaluate putative progression risk factors in a PUV cohort.

Methods

We conducted a review of all PUV patients followed in CKiD. Kidney function (ieGFR) was assessed using either measured iGFR (plasma iohexol disappearance) or the CKiD U25 formula eGFR (for visits where iGFR was not done). Inclusion criteria were ieGFR >20 ml/min/1.73 m² and ≥2 ieGFRs after age 1 year. The primary outcome was annualized change in ieGFR, assessed with linear mixed effects models. The association of proteinuria, hypertension (HTN), and metabolic acidosis with ieGFR decline were also investigated using linear mixed models. CKD progression was also analyzed as a binary outcome, with progression defined as reaching the composite endpoint of death, dialysis, kidney transplant, CKD stage V not on kidney replacement therapy (KRT) or >50% decline in ieGFR.

Results

A total of 102 PUV patients met the inclusion criteria. Median [IQR] age at baseline was 5.0 [3.5,9.1] yrs and follow up time was 6.1 [3.1,8.9] yrs. iGFRs were 39% of the measures. Median [IQR] baseline ieGFR was 50.1 [38,64].The absolute rate of ieGFR decline was -1.8 (95% CI -2.5, -1.0) ml/min/1.73 m²/year. Overall, 38 (37%) patients reached the composite endpoint of dialysis (n=3), transplant (n=12), CKD stage V not on KRT (n=8) or >50% ieGFR decline (n=15). Proteinuria was significantly associated with faster progression (p = 0.026). HTN and metabolic acidosis did not achieve statistical significance.

Conclusion

PUV patients show progressive loss of kidney function that varies by individual. Proteinuria was associated with faster progression, suggesting its role as a modifiable risk factor in this non-glomerular disease cohort.

Funding

• NIDDK Support