A recent study by faculty in the Division of Pediatric Urology at UPMC Children’s Hospital of Pittsburgh investigates the relationship between socioeconomic factors and disease progression in children with posterior urethral valves (PUV). The article, “Posterior Urethral Valves: Examining the Relationship of Socioeconomic Factors in Disease Presentation and Progression,” was published online ahead of print in Journal of Pediatric Urology.
UPMC Children's authors include Christopher Staniorski, MD; Rajeev Chaudhry, MD; and Omar Ayyash, MD. Other authors include Mary Killian, MD; Devin Rogers, MD; and John Flinn, MD.
Understanding Posterior Urethral Valves and Associated Risks
Posterior urethral valves are a leading cause of urinary tract obstruction in male infants and remain a significant risk factor for progression to end-stage renal disease (ESRD), even with appropriate surgical and medical management. Early detection and postnatal care are critical in influencing long-term outcomes.
Does Community Disadvantage Predict Worse Renal Outcomes?
In this retrospective review of 145 patients treated at UPMC Children’s over two decades, higher levels of community disadvantage — measured by the Area Deprivation Index (ADI) — were associated with earlier diagnosis and increased rates of dialysis. Patients from disadvantaged areas were more likely to present before 6 months of age and required dialysis more frequently, suggesting more severe disease at birth.
Despite these findings, the strongest predictor of progression to renal transplant was elevated serum creatinine (>1.0 mg/dL) within one year of valve ablation. Insurance status showed no correlation with outcomes.
Clinical Takeaways
Children from disadvantaged communities were more likely to experience early diagnosis and require dialysis, indicating more severe initial disease presentation. While long-term outcomes such as transplant were driven by early renal function markers, these findings emphasize the role of socioeconomic factors in shaping early disease trajectory. Incorporating social determinants of health into care strategies may support earlier interventions and tailored monitoring for high-risk patients.
Reference
Staniorski CJ, Killian M, Rogers D, Flinn J, Chaudhry R, Ayyash O. Posterior urethral valves: Examining the relationship of socioeconomic factors in disease presentation and progression. J Pediatr Urol. Published online January 19, 2025.
