LONG-TERM RENAL OUTCOMES IN ADULTS WITH HISTORY OF CHILDHOOD POSTERIOR URETHRAL VALVE: A MULTI-CENTER PROSPECTIVE COHORT STUDY FROM MAJOR NEPHROLOGY CENTERS IN INDIA

Background: Posterior urethral valve (PUV) is the most prevalent source of congenital bladder outlet obstruction in males, with an incidence of approximately 1 in 5,000 to 8,000 live male births. Even with early surgical management, many patients progress to chronic kidney disease (CKD) in adulthood through vesicoureteral reux and recurrent pyelonephritis. This study aims to examine the pathway of progression from PUV in childhood to adult ckD, as well as to identify modiable risk factors. Methods: We undertook a prospective multicenter cohort investigation of children in whom PUVs had been identied and conrmed prior to the age of 18 years in nephrology clinics across public and private funding sources in India from September 2024 to September 2025. Adult patients (≥18 years) with a history of childhood PUV were invited into the study and assessed for CKD progression, reux nephropathy, and pyelonephritis history. Results: 287 patients were recruited; of these, 68.3% went on to develop CKD stage 3-5 at 28.4 years of age. Recurrent pyelonephritis (≥3 distinct episodes) was documented in 74.2% of patients with CKD. Persistent vesicoureteral reux after valve ablation was noted in 61.4% of patients with CKD progression versus 23.1% of patients without CKD progression (p<0.001). Conclusions: A childhood history of PUV carries a signicant risk for CKD in adulthood, with reux related pyelonephritis being the primary consequence. Early detection and aggressive management of vesicoureteral reux could prevent more severe long-term renal outcomes