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. 2019 Apr 2:7:120.
doi: 10.3389/fped.2019.00120. eCollection 2019.

A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract

Mariana A Vasconcelos  1 , Eduardo A Oliveira  1   2 , Ana Cristina Simões E Silva  1   3 , Cristiane S Dias  1 , Robert H Mak  2 , Carolina C Fonseca  4 , Ana Paula M Campos  4 , Ewout W Steyerberg  5 , Yvonne Vergouwe  5
Affiliations

A Predictive Model of Postnatal Surgical Intervention in Children With Prenatally Detected Congenital Anomalies of the Kidney and Urinary Tract

Mariana A Vasconcelos et al. Front Pediatr. .

Abstract

The aim of this study was to identify predictive factors and develop a model to assess individualized risk of postnatal surgical intervention in patients with antenatal hydronephrosis. This is a retrospective cohort study of 694 infants with prenatally detected congenital anomalies of kidney and urinary tract with a median follow-up time of 37 months. The main event of interest was postnatal surgical intervention. A predictive model was developed using Cox model with internal validation by bootstrap technique. Of 694 patients, 164 (24%) infants underwent surgical intervention in a median age of 7.8 months. Predictors of the surgical intervention in the model were: baseline glomerular filtration rate, associated hydronephrosis, presence of renal damage and the severity of renal pelvic dilatation. The optimism corrected c statistic for the model was 0.84 (95%CI, 0.82-0.87). The predictive model may contribute to identify infants at high risk for surgical intervention. Further studies are necessary to validate the model in patients from other settings.

Keywords: antenatal hydronephrosis; congenital anomalies of kidney and urinary tract; predictive model; prenatal diagnosis; surgical intervention.

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Figures

Figure 1
Figure 1
Kaplan Meier estimates the risk of surgical intervention stratified according to (A) renal function at baseline; (B) associated hydronephrosis; (C) renal damage; (D) renal pelvic dilatation; and (E) period of admission.
Figure 2
Figure 2
Nomogram for predicting 2 years risk of surgery based on 5 predictors; estimated glomerular renal function in mL/min/1.73 m2 (eGFR), associated hydronephrosis, renal damage, APRPD (anteroposterior renal pelvis diameter) in mm, period of admission (before 2000); 2-year risk of surgery.
Figure 3
Figure 3
Kaplan Meier plot for risk of surgery according to risk category. Low-risk category, <20 points; Medium-risk category, 20–28 points; High-risk category, 29+ points.
Figure 4
Figure 4
Agreement between predicted 2-year risk of surgery and observed risk.
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