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. 2022 Mar;37(3):613-623.
doi: 10.1007/s00467-021-05254-x. Epub 2021 Aug 28.

Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury

Fernanda F Melo  1 , Mariana A Vasconcelos  1 , Robert H Mak  2 , Ana Cristina Simões E Silva  1 , Cristiane S Dias  1 , Enrico A Colosimo  3 , Ludmila R Silva  1 , Maria Christina L Oliveira  1 , Eduardo A Oliveira  4   5
Affiliations

Postnatal urinary tract dilatation classification: improvement of the accuracy in predicting kidney injury

Fernanda F Melo et al. Pediatr Nephrol. 2022 Mar.

Abstract

Background: The grading of urinary tract dilatation (UTD) on postnatal sonography is a fundamental step to establish rational management for infants with antenatal hydronephrosis (ANH). The aim of this study was to compare the prediction accuracy of UTD grading systems for relevant clinical outcomes. In addition, we propose a refinement of the UTD classification by adding quantitative measurements and evaluate its impact on accuracy.

Methods: Between 1989 and 2019, 447 infants diagnosed with isolated AHN were prospectively followed. The events of interest were surgical interventions and kidney injury. Comparison of performance of the grading systems and the impact on the accuracy of a modified UTD classification (including the size of the kidney parenchyma) was assessed by the area under the receiver-operating characteristic curve (AUC).

Results: Of 447 infants, 131 (29%) underwent surgical intervention and 26 (5.8%) had developed kidney injury. The median follow-up time was 9 years (IQ range, 7-12 years). The performance for detecting the need for surgical intervention was excellent for all grading systems (AUC > 0.90). However, for predicting kidney injury, the modified UTD classification exhibited significant improvement in accuracy (AUC = 0.913, 95%CI, 0.883-0.937) as compared with UTD classification (AUC = 0.887, 95%CI, 0.854-0.915) (P = 0.027).

Conclusions: Our study confirms that the hydronephrosis grading systems provide excellent accuracy in discriminating patients who need surgical intervention among infants with AHN. Our findings suggest that the inclusion of kidney parenchymal thickness to UTD classification might increase the accuracy for predicting infants who may develop kidney injury. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Fetal hydronephrosis; Ureteropelvic junction obstruction; Urinary tract dilatation; Urinary tract infection.

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References

    1. Lee RS, Cendron M, Kinnamon DD, Nguyen HT (2006) Antenatal hydronephrosis as a predictor of postnatal outcome: a meta-analysis. Pediatrics 118:586–593 - DOI
    1. Oliveira EA, Oliveira MC, Mak RH (2016) Evaluation and management of hydronephrosis in the neonate. Curr Opin Pediatr 28:195–201 - DOI
    1. Chiodini B, Ghassemi M, Khelif K, Ismaili K (2019) Clinical outcome of children with antenatally diagnosed hydronephrosis. Front Pediatr 7:103 - DOI
    1. Dos Santos J, Parekh RS, Piscione TD, Hassouna T, Figueroa V, Gonima P, Vargas I, Farhat W, Rosenblum ND (2015) A new grading system for the management of antenatal hydronephrosis. Clin J Am Soc Nephrol 10:1783–1790 - DOI
    1. Costa FP, Simões e Silva AC, Mak RH, Ix JH, Vasconcelos MA, Dias CS, Fonseca CC, Oliveira MCL, Oliveira EA (2020) A clinical predictive model of renal injury in children with isolated antenatal hydronephrosis. Clin Kidney J 13:834–841 - DOI

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