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

Vasconcelos, Marisa; Oliveira, Eduardo A.; Silva, Ana Cristina Simões e; Dias, Camila Carneiro; Mak, Robert H.; Fonseca, Carolina C; Campos, Ana Paula M; Vergouwe, Yvonne

doi:10.3389/fped.2019.00120

Cited by 7 publications

(2 citation statements)

References 43 publications

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“…However, there is no consensus on the criteria for surgical intervention. Cox proportional hazards regression has been applied to assess the association between candidate predictors, such as eGFR, associated hydronephrosis, kidney damage, and the severity of dilatation of renal pelvis, and the need of surgery in children with prenatally detected CAKUT 13 . In addition, some possible indications for surgery, according to the classification of the Society for Fetal Urology (SFU) of 2015 14 , include grade 4 or 5 of hydronephrosis, in which there is dilation of the renal calyces with impaired renal parenchyma 12 .…”

Section: Discussionmentioning

confidence: 99%

Non-surgical management of vesicoureteral junction obstruction: a case report

et al. 2022

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Objective: To report the case of a pediatric patient with bilateral hydronephrosis due to vesicoureteral junction obstruction (VUJO) that was treated non-surgically and to discuss the approach of this anomaly. Case Description: A 25-month-old boy was referred without complaints for consultation due to prenatal ultrasound showing kidneys with cysts. He was under antibiotic prophylaxis. No family history of kidney disease and/or inherited disorders was reported. Renal ultrasound (RUS) at 2 days of life showed bilateral hydronephrosis, thus ruling out the possibility of kidney cystic disease. Dynamic renal scintigraphy (DTPA) showed marked retention of the marker in the pyelocaliceal system bilaterally, with little response to diuretic drug. He was maintained under antibiotic prophylaxis, when a new RUS showed bilateral ureteral dilatation, abrupt stenosis in the ureterovesical transition region (0.2 cm caliber), moderate bilateral hydronephrosis, and slight renal cortical thickness, confirming the diagnosis of VUJO. At 2 years and 10 months of age, DTPA showed hydronephrosis and ureteral stasis in both kidneys secondary to stenosis at the vesicoureteral junction (VUJ) level, with preservation of kidney function and slow degree of emptying. We opted for a non-surgical approach. RUS at 10 years of age showed significant improvement of all parameters, with ureteral transverse diameter of 9 mm, preserved VUJ, and age-appropriate bilateral kidney development. Comments: VUJO is a major cause of prenatal hydronephrosis and can trigger a deterioration of kidney function. Its treatment is still controversial but should take into account the importance of clinical follow-up and serial imaging evaluation.

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Section: Discussionmentioning

confidence: 99%

Non-surgical management of vesicoureteral junction obstruction: a case report

et al. 2022

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“…The predictive models have been extensively useful in medical practice to screen for diseases, establish diagnosis and prognosis to guide therapeutical decision-making, and inform patients about the possible natural history of certain conditions or prognoses after some intervention received [ 12 ]. Commonly, quite complex health-related multivariate models are developed and tested [ 13 , 14 ]. From other areas of knowledge, we can observe that the most complex models better predict an outcome of interest [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

How combining different caries lesions characteristics may be helpful in short-term caries progression prediction: model development on occlusal surfaces of primary teeth

et al. 2021

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Background Few studies have addressed the clinical parameters' predictive power related to caries lesion associated with their progression. This study assessed the predictive validity and proposed simplified models to predict short-term caries progression using clinical parameters related to caries lesion activity status. Methods The occlusal surfaces of primary molars, presenting no frank cavitation, were examined according to the following clinical predictors: colour, luster, cavitation, texture, and clinical depth. After one year, children were re-evaluated using the International Caries Detection and Assessment System to assess caries lesion progression. Progression was set as the outcome to be predicted. Univariate multilevel Poisson models were fitted to test each of the independent variables (clinical features) as predictors of short-term caries progression. The multimodel inference was made based on the Akaike Information Criteria and C statistic. Afterwards, plausible interactions among some of the variables were tested in the models to evaluate the benefit of combining these variables when assessing caries lesions. Results 205 children (750 surfaces) presented no frank cavitations at the baseline. After one year, 147 children were reassessed (70%). Finally, 128 children (733 surfaces) presented complete baseline data and had included primary teeth to be reassessed. Approximately 9% of the reassessed surfaces showed caries progression. Among the univariate models created with each one of these variables, the model containing the surface integrity as a predictor had the lowest AIC (364.5). Univariate predictive models tended to present better goodness-of-fit (AICs < 388) and discrimination (C:0.959–0.966) than those combining parameters (AIC:365–393, C:0.958–0.961). When only non-cavitated surfaces were considered, roughness compounded the model that better predicted the lesions' progression (AIC = 217.7, C:0.91). Conclusions Univariate model fitted considering the presence of cavitation show the best predictive goodness-of-fit and discrimination. For non-cavitated lesions, the simplest way to predict those lesions that tend to progress is by assessing enamel roughness. In general, the evaluation of other conjoint parameters seems unnecessary for all non-frankly cavitated lesions.

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