A New Grading System for the Management of Antenatal Hydronephrosis

Abstract

Background and objectives Standard clinical assessments do not predict surgical intervention in patients with a moderate degree of upper tract hydronephrosis. This study investigated whether combined measures of renal calyceal dilation and anteroposterior diameter (APD) of the renal pelvis at the first postnatal ultrasound better predict surgical intervention beyond standard assessments of the APD or Society of Fetal Urology (SFU) grading system.Design, setting, participants, & measurements A retrospective cohort of 348 children with antenatal hydronephrosis followed from 2003 to 2013 were studied. Using Cox regression, the risk for surgery by APD, SFU, and combined grading on the basis of the first postnatal ultrasound was calculated. The predictive capability of each grading system for surgery was determined by calculating the positive likelihood ratio (LR+).Results The combination of APD$6-9 mm and diffuse caliectasis had a hazard ratio (HR) of 19.5 (95% confidence interval [95% CI], 3.94 to 96.9) versus 0.59 (95% CI, 0.05 to 6.53) for APD$6-9 mm alone and a similar risk of 8.9 for SFU grade 3 (95% CI, 3.84 to 20.9). The combination of APD$9-15 mm and diffuse caliectasis had an HR of 18.7 (95% CI, 4.36 to 80.4) versus 1.75 (95% CI, 0.29 to 10.5) for APD$9-15 mm alone. The LR+ for surgery for diffuse caliectasis and APD$6-9 mm was higher than for APD$6-9 mm alone (HR=2.62; 95% CI, 0.87 to 7.94 versus HR=0.04; 95% CI, 0.01 to 0.32) and was higher for APD$9-15 mm and diffuse caliectasis than APD$9-15 mm alone (HR=2.0; 95% CI, 1.15 to 3.45 versus HR=0.14; 95% CI, 0.04 to 0.43). Both combined groups of moderate hydronephrosis (APD$6-9 mm or $9-15 mm with diffuse caliectasis) had only slightly higher LR+ than SFU grade 3 (HR=1.89; 95% CI, 1.17 to 3.05).Conclusions These results suggest a grading system combining APD and diffuse caliectasis distinguishes those children with moderate degrees of upper tract hydronephrosis that are at higher risk of surgery.

Predictive Factors of Contralateral Operation after Initial Pyeloplasty in Children with Antenatally Detected Bilateral Hydronephrosis Due to Ureteropelvic Junction Obstruction

“…We have herein evaluated the association of the APD, calyceal dilatation, and C/P ratio with the need for surgical intervention for contralateral hydronephrosis. Measurement of the APD is commonly performed to determine the severity of hydronephrosis [12-14]. However, no universally agreed-upon reference range for the APD has been established.…”

Elevated urinary lipocalin-2, interleukin-6 and monocyte chemoattractant protein-1 levels in children with congenital ureteropelvic junction obstruction

“…Urine from 17 age-and sex-matched healthy controls with normal renal function from a general pediatric clinic (male Z 16, female Z 1, median age Z 78 months) was collected. Patients with UPJO who met the criteria for surgery described previously [10,11] underwent dismembered pyeloplasty for correction of their obstruction, and urine samples were collected as detailed in the following section. One patient with mild hydronephrosis did not undergo surgery.…”

The fate of antenatal renal pelvis dilatation: a prospective postnatal cohort study

“…In contrast, great variability is seen in patients with moderate grades of hydronephrosis. 3 Society for Fetal Urology grading system and the measurement of the anteroposterior diameter of the renal pelvis (APD) represents the two most common standardized systems for evaluating hydronephrosis. [4][5][6] This prospective study was conducted to analyze the clinical results of infants with antenatal diagnosed hydronephrosis and to ascertain whether there is any correlation between the renal pelvic diameter (APD) and the urinary tract abnormalities detected.…”