Diagnostic accuracy of postnatal renal pelvic diameter as a predictor of uropathy: a prospective study

Bouzada, Maria Cândida Ferrarez; Oliveira, Eduardo A.; Pereira, Alamanda Kfoury; Leite, Henrique Vítor; Rodrigues, A. M.; Fagundes, Lívia A; Gonçalves, Ricardo; Parreiras, R. L.

doi:10.1007/s00247-004-1283-8

Cited by 31 publications

(30 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the first decade of the study, infants were investigated according to a comprehensive systematic protocol described elsewhere (14)(15)(16). After 2000, we developed a more tailored clinical protocol (17)(18)(19). Briefly, a renal ultrasonography (US) was performed after the first week of postnatal life, and all infants with confirmed hydronephrosis underwent a voiding cystourethrogram (VCUG).…”

Section: Study Protocolmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives With the advent of fetal screening ultrasonography, the detection of congenital anomalies of the kidney and urinary tract (CAKUT) in utero has permitted early management of these conditions. This study aims to describe the clinical course of a large cohort of patients with prenatally detected nephrouropathies.Design, setting, participants, & measurements In this retrospective cohort study, 822 patients were prenatally diagnosed with CAKUT and systematically followed up at a tertiary Renal Unit for a median time of 43 months. Variables included in the analysis were sex, laterality, fetal ultrasonography (isolated versus associated hydronephrosis), and presence/absence of nephrouropathies. The events of interest were urinary tract infection, surgical interventions, hypertension, CKD, and death. Survival analyses were performed to evaluate time until occurrence of the events of interest.Results Urinary tract infection occurred in 245 (29.8%) children, with higher risk in females (hazard ratio=1.30, 95% confidence interval=1.02-1.70, P=0.05); 22 patients (2.7%) had hypertension, and 49 (6%) patients developed CKD. The risk of CKD was greater in patients with associated hydronephrosis (hazard ratio=5.20, 95% confidence interval=2.90-9.30, P,0.001). Twelve patients (1.5%) died during follow-up. Death was significantly associated with being born during the first period of the study (hazard ratio=6.00, 95% confidence interval=1.60-22.50, P,0.001), associated hydronephrosis (hazard ratio=9.30, 95% confidence interval=2.90-29.30, P,0.001), and CKD (hazard ratio=170.00, 95% confidence interval=41.00-228.00, P,0.001).Conclusions In our series, the clinical course of prenatally detected CAKUT was heterogeneous, and those infants with associated hydronephrosis at baseline were identified as a high-risk subgroup.

show abstract

Section: Study Protocolmentioning

confidence: 99%

“…Clinical examination (including growth and BP measurements), US, and laboratory reviews (including urine culture and serum creatinine) were scheduled at 6-month intervals. When the VCUG was normal but postnatal US showed renal pelvis dilatation (RPD) $10 mm, renal scintigraphy was performed after the first month (11,18,19).…”

Section: Study Protocolmentioning

confidence: 99%

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Quirino

Diniz

Bouzada

et al. 2012

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…After the initial US, patients underwent urinary tract imaging according to a systematic protocol described in detail elsewhere [14,15]. Urine cultures were obtained at monthly follow-up visits.…”

Section: Methodsmentioning

confidence: 99%

Outcome of Antenatal Hydronephrosis

Çonkar¹

2016

Ann Clin Lab Res

View full text Add to dashboard Cite

“…Similarly, 42%-100% of patients with SFU grade 2 and 27%-89% of patients with SFU grade 3 stabilize or improve (1). Given the wide variation in outcomes in children with moderate degrees of hydronephrosis, there exists no clear consensus on criteria for surgical intervention on the basis of ultrasound measurements (3,4,(10)(11)(12). As a result, current practice is far from uniform, often on the basis of physician or institutional individual practices.…”

Section: Introductionmentioning

confidence: 99%

A New Grading System for the Management of Antenatal Hydronephrosis

Santos

Parekh

Piscione

et al. 2015

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

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.

show abstract

Diagnostic accuracy of postnatal renal pelvic diameter as a predictor of uropathy: a prospective study

Abstract: Our results suggest that postnatal APD is an excellent test for identifying fetuses with significant uropathy, as well as those requiring postnatal intervention.

Cited by 31 publications

References 31 publications

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Clinical Course of 822 Children with Prenatally Detected Nephrouropathies

Outcome of Antenatal Hydronephrosis

A New Grading System for the Management of Antenatal Hydronephrosis

Contact Info

Product

Resources

About